Shielded reciprocating surgical file

ABSTRACT

The invention relates to shielded reciprocating surgical file system for precisely removing bone and/or other tissue material. The system allows a user to maneuver the system and navigate into hard to access sites under a direct vision mechanism included in the system. A transmission mechanism converts rotary motion from a motor into reciprocating motion and provides it to the surgical file for precision bone and/or tissue removal. A pulsatile pump mechanism is operatively coupled with the transmission mechanism and provides irrigating fluid to the surgical site.

RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. ProvisionalApplication No. 60/414,690, filed Sep. 27, 2002, entitled SHIELDEDRECIPROCATING SURGICAL FILE, the entirety of which is herebyincorporated by reference herein.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] The invention relates generally to systems and methods for tissuecutting and removal. More particularly, the invention relates to ashielded reciprocating surgical file system for cutting, removing,grinding, shaping and sculpturing bone and/or tissue material underdirect vision.

[0004] 2. Description of the Related Art

[0005] Adjacent spinal vertebrae are spaced by intervertebral discs thatare tough and semi-elastic. The discs act as a flexible spacer betweenthe vertebrae that makeup the backbone. Vertebrae are shaped to providea bony tubular shaped tunnel between upper and lower pairs of vertebraeand this tunnel is made-up in part by the spacing disc. These tubularshaped tunnels are called neuroforamen and serve as a passageway fornerve roots. The size of the neuroforamen tubular shaped tunnels is aclose fit for the nerve roots that pass through these tunnels on theirway from the spinal cord to the arms, legs and other muscles.

[0006] Each year millions of people encounter neck and back injuries.Many million suffer from truly problematic back pain that either keepsthem out of work or debilitates them in some way. Many vertebral anddisc injuries result in pain from nerve irritation and compression.

[0007] When an intervertebral disc is damaged, often it is because of aphysical overrotation between two vertebrae and normal wear and tear.When a vertebra is overrotated, small facet joints called thezygapophyseal capsules that are located to the left and right sides ofthe disc are damaged. When the body incurs damage to these small joints,unwanted osteophytes and bony overgrowths frequently occur at the edgesof these tiny joints. The unwanted bony overgrowth restricts theneuroforamen and pinches the delicate and sensitive nerve roots.

[0008] Also, with age, for many people, the sensation of thirst issomewhat reduced. As a result, sometimes less water is consumed thanneeded by the body. The intervertebral discs depend on water as well asother materials to maintain a healthy function. When a disc looses apart of its fluid mass it is said to desiccate. When a disc isdesiccated it reduces in height and reduces the space between the twovertebras it is connected to, that is, the neuroforamen becomesconstricted and pinches nerve roots.

[0009] Pinched nerves that are constrained in between vertebras cancause neck and back pain. The bony overgrowth and a reduction in thespace between vertebras pinch the nerves causing irritation, pain andnumbness. The pinching can potentially result in a loss of use of thelimbs controlled by the affected nerve.

[0010] Thus, when intervertebral discs are damaged from accident, ageand/or general wear and tear the intervertebral nerve roots in theneuroforamen are irritated and pinched and can cause unwantedinvoluntary muscular contractions. The muscle contractions can come inthe form of a continuous low-grade ache or become more severe as aspasm. The muscle contractions can act to further compress the spacebetween the vertebras, which further pinches the nerve. This becomes aseverely painful, self-destructive and self-feeding problem.

[0011] One current technology to treat a patient with nerve compressionthat causes pain and numbness involves the removal of the disc andfusion of the vertebra below with the vertebra above it. Vertebralfusion removes a disc that was flexible and fuses one vertebra togetherwith the adjacent vertebra resulting in a rigid joint between twovertebrae. This causes added strain on the disc above and below the nowrigid bone fusion. Sometimes the attempted fusion of one vertebra ontoanother vertebra is unsuccessful and does not provide the intendedfusion.

[0012] Disadvantageously, the intervertebral fusion is an invasive andrelatively complicated procedure. In addition, and undesirably, thefusion process can result in a long hospital stay for the patient, along recuperation and rehabilitation period and high costs for both thepatient and care providers.

SUMMARY OF THE INVENTION

[0013] Embodiments of the invention overcome some or all of the abovedisadvantages by providing systems and methods for tissue cutting andremoval including a shielded reciprocating surgical file and a directvision apparatus. Some embodiments provide surgical instrumentation thatallows a surgeon to navigate into the tiny neuroforamen next to delicatenerves under direct vision, and locate and remove obstructions of tissuethat can cause nerve compression and irritation. Advantageously, thisoffers many patients a minimally invasive surgical option that canresult in shorter hospital stays and lower cost.

[0014] Embodiments of the invention can desirably be adapted andtailored to serve at least three surgical fields. These include, but arenot limited to, neurosurgery, orthopaedic surgery and plastic surgery.The neurosurgical embodiments enable surgeons to safely enlarge theconstricted neuroforamen and provide more space for the nerve roots topass through the rigid bony vertebral structure, thereby relieving thenerve pinching and compression.

[0015] The orthopaedic embodiments provide improved bone and/or tissueremoval instrumentation and methodology, for example, for orthopaedicsurgical procedures such as knee surgery. The plastic surgeryembodiments provide improved bone and/or tissue sculpturinginstrumentation and methodology, for example, for cosmetic surgicalprocedures such as nose reshaping or rhinoplasty.

[0016] Some embodiments include a surgical instrument comprising ablade; a housing in which the blade moves, the housing having a longaxis; a transmission that converts rotary motion to reciprocating,linear motion, wherein the transmission is coupled to the blade suchthat the blade moves reciprocally in the housing; a first opening in thehousing through which a portion of the blade is exposed; and a cuttingsurface on the exposed portion of the blade, the surface configured toperform at least one of grinding, filing, and cutting of tissue.

[0017] In some embodiments the housing is concave about at least aportion of its long axis, such as at least a distal portion of its longaxis. In some embodiments the housing is convex about at least a portionof its long axis, such as at least a distal portion of its long axis. Insome embodiments the first opening is in an opening surface on thehousing. In some embodiments the housing is curved along its long axis,to assist in placing the surgical instrument in the body of a patient.In some embodiments the blade is substantially flat.

[0018] In some embodiments the housing is curved along its long axis ina direction toward the opening surface. Some embodiments furthercomprise at least one bearing retainer for reducing friction. In someembodiments the at least one bearing retainer has at least one slotconfigured to transmit fluid toward a distal end of the instrument. Someembodiments further comprise at least one fiberoptic in or on thehousing, for transmission of at least one of a video signal andillumination light. In some embodiments the housing has at least asecond opening at a distal end of the housing.

[0019] Some embodiments further comprise at least two lenses coupled tothe at least one fiberoptic. In some embodiments, at least one of the atleast two lenses is disposed at a distal end of the housing, and anotherof the at least two lenses is disposed in proximity to the first openingin the housing. Some embodiments further comprise a pump for pumpingfluid through the surgical instrument. In some embodiments the pump ismechanically coupled to the transmission. In some embodiments, thetransmission comprises: two surfaces that are a substantially fixeddistance apart; a cam that rotates about a central axis, the centralaxis being at an angle to a plane extending between the two surfaces;and the cam having a curvilinear body, the body having a nonuniformthickness, wherein the body continuously contacts the two surfaces asthe cam rotates about the central axis, such that the two surfacesremain at the substantially fixed distance apart as they move linearlyin response to the cam's rotation about the central axis.

[0020] In some embodiments, the cam's central axis is substantiallyparallel to a direction of the linear motion of the two surfaces. Insome embodiments, the central axis is substantially perpendicular to theplane extending between the two surfaces. In some embodiments the twosurfaces move linearly back and forth in reciprocating motion inresponse to the cam's rotation about the central axis. In someembodiments the curvilinear body has a shape comprising at least twotoruses, the at least two toruses being partially superimposed, and eachof the at least two toruses has a central axis, wherein the central axesof the at least two toruses are at an angle to each other. In someembodiments at least one bearing comprises the two surfaces. In someembodiments two bearings respectively comprise the two surfaces.

[0021] In some embodiments the curvilinear body is disposed at an angleto the central axis of the cam. Some embodiments include an apparatusfor translating a rotary motion to a linear motion, the apparatuscomprising: two surfaces that are a substantially fixed distance apart;and a cam that rotates about a central axis, the central axis being atan angle to a plane extending between the two surfaces; the cam having acurvilinear body, the body having a nonuniform thickness, wherein thebody continuously contacts the two surfaces as the cam rotates about thecentral axis, such that the two surfaces remain at the substantiallyfixed distance apart as they move linearly in response to the cam'srotation about the central axis.

[0022] In some embodiments the cam's central axis is substantiallyparallel to a direction of the linear motion of the two surfaces. Insome embodiments the central axis is substantially perpendicular to theplane extending between the two surfaces. In some embodiments the twosurfaces move linearly back and forth in reciprocating motion inresponse to the cam's rotation about the central axis. In someembodiments the curvilinear body has a shape comprising at least twotoruses, the at least two toruses being partially superimposed, and eachof the at least two toruses has a central axis, wherein the central axesof the at least two toruses are at an angle to each other.

[0023] In some embodiments at least one bearing comprises the twosurfaces. In some embodiments two bearings respectively comprise the twosurfaces. In some embodiments the curvilinear body is disposed at anangle to the central axis of the cam. Some embodiments include a pumpcomprising: a fluid path; two plungers configured to at least partiallyocclude the fluid path; a cam configured to cause the two plungers to atleast partially occlude the fluid path alternatingly; and at least onecheck valve along the fluid path for reducing backflow of fluid withinthe fluid path.

[0024] In some embodiments the cam translates in a direction that issubstantially perpendicular to a long axis of at least one of the twoplungers. In some embodiments the cam translates in a direction that issubstantially perpendicular to a long axis of each of the two plungers.In some embodiments the pump comprises: a fluid path; two plungersconfigured to at least partially occlude the fluid path; a camconfigured to cause the two plungers to at least partially occlude thefluid path alternatingly; and at least one check valve along the fluidpath for reducing backflow of fluid within the fluid path.

[0025] In some embodiments the cam translates in a direction that issubstantially perpendicular to a long axis of at least one of the twoplungers. In some embodiments the cam translates in a direction that issubstantially perpendicular to a long axis of each of the two plungers.Some embodiments of the instrument further comprise at least one openingin the exposed portion of the blade, for transmitting fluid. In someembodiments the cutting surface comprises an abrasive material. In someembodiments the cutting surfaces comprises diamond. In some embodimentsthe blade comprises stainless steel.

[0026] Some embodiments further comprise a handpiece coupled to thehousing. Some embodiments further comprise a video camera. In someembodiments the camera is configured to couple with a fiberoptic thatextends to a distal end of the housing. In some embodiments a videocamera is located in the handpiece. Some embodiments further comprise awatertight seal in the handpiece. In some embodiments the handpiece isconfigured to contain the video camera in a chamber such that thewatertight seal reduces or prevents ingress of at least one of water andbacteria from outside the handpiece into the chamber containing thevideo camera in the handpiece.

[0027] Some embodiments further comprise a motor in the handpiece, themotor configured to power the rotary motion. In some embodiments themotor comprises a gas turbine. Some embodiments further comprise a cordconfigured to couple to a proximal end of the surgical instrument, thecord comprising at least one of a fiberoptic, an electrical line, anirrigation channel, a suction line, and a gas tube for powering a gasturbine motor in the surgical instrument.

[0028] For purposes of summarizing the invention, certain aspects,advantages and novel features of the invention have been describedherein above. Of course, it is to be understood that not necessarily allsuch advantages may be achieved in accordance with any particularembodiment of the invention. Thus, the invention may be embodied orcarried out in a manner that achieves or optimizes one advantage orgroup of advantages as taught or suggested herein without necessarilyachieving other advantages as may be taught or suggested herein.

[0029] All of these embodiments are intended to be within the scope ofthe invention herein disclosed. These and other embodiments of theinvention will become readily apparent to those skilled in the art fromthe following detailed description of the preferred embodiments havingreference to the attached figures, the invention not being limited toany particular preferred embodiment(s) disclosed.

BRIEF DESCRIPTION OF THE DRAWINGS

[0030] Having thus summarized the general nature of the invention andsome of its features and advantages, certain preferred embodiments andmodifications thereof will become apparent to those skilled in the artfrom the detailed description herein having reference to the figuresthat follow, of which:

[0031]FIG. 1 is a simplified schematic view of a surgical file systemillustrating features and advantages in accordance with an embodiment ofthe invention.

[0032]FIG. 2 is a simplified perspective view of the surgical filesystem of FIG. 1.

[0033]FIG. 3 is a simplified perspective view of a surgical file devicewith a curved distal tip configuration illustrating features andadvantages in accordance with an embodiment of the invention.

[0034]FIG. 4 is a simplified perspective view of a surgical file devicewith a straight distal tip configuration illustrating features andadvantages in accordance with another embodiment of the invention.

[0035]FIG. 5 is a simplified side view of a surgical file deviceillustrating features and advantages in accordance with an embodiment ofthe invention.

[0036]FIG. 6 is a simplified partially exploded view of the surgicalfile device of FIG. 5.

[0037]FIG. 7 is a simplified perspective view of the surgical filedevice of FIG. 5 with the distal cover removed illustrating features andadvantages in accordance with an embodiment of the invention.

[0038]FIG. 8 is a simplified perspective view of a distal tip assemblyof the surgical file device of FIG. 5.

[0039]FIG. 9 is a simplified exploded perspective view of the distal tipassembly of FIG. 8 illustrating features and advantages in accordancewith an embodiment of the invention.

[0040]FIG. 10 is a sectional view along line 10-10 of FIG. 5illustrating features and advantages in accordance with an embodiment ofthe invention.

[0041]FIG. 11 is a sectional view along line 11-11 of FIG. 5illustrating features and advantages in accordance with an embodiment ofthe invention.

[0042]FIG. 12 is a simplified perspective view of a surgical cuttingblade illustrating features and advantages in accordance with anembodiment of the invention.

[0043]FIG. 13 is a simplified schematic cross-section view of a convexsurgical file cutting surface illustrating features and advantages inaccordance with an embodiment of the invention.

[0044]FIG. 14 is a simplified schematic cross-section view of a concavesurgical file cutting surface illustrating features and advantages inaccordance with another embodiment of the invention.

[0045]FIG. 15 is a simplified schematic side view sectional view ofsurgical file distal tip with a top cutting surface illustratingfeatures and advantages in accordance with an embodiment of theinvention.

[0046]FIG. 16 is a simplified schematic side sectional view of asurgical file distal tip with a top cutting surface illustratingfeatures and advantages in accordance with another embodiment of theinvention.

[0047]FIG. 17 is a simplified perspective view of a surgical filecutting surface with abrasives illustrating features and advantages inaccordance with an embodiment of the invention.

[0048]FIG. 18 is a simplified perspective view of a surgical filecutting surface with irrigation fluid openings illustrating features andadvantages in accordance with an embodiment of the invention.

[0049]FIG. 19 is a simplified schematic view of a surgical file cuttingblade with irrigation fluid flow therethrough illustrating features andadvantages in accordance with an embodiment of the invention.

[0050]FIG. 20 is a simplified schematic cross-section view of a surgicalfile distal cutting tip with irrigation fluid passageways illustratingfeatures and advantages in accordance with an embodiment of theinvention.

[0051]FIG. 21 is a simplified side sectional view of a surgical filedistal cutting tip with a linear reciprocation stroke illustratingfeatures and advantages in accordance with an embodiment of theinvention.

[0052]FIG. 22 is a simplified side sectional view of a surgical filedistal cutting tip with fiber optic probes illustrating features andadvantages in accordance with an embodiment of the invention.

[0053]FIG. 23 is a simplified sectional view along line 23-23 of FIG. 22illustrating features and advantages in accordance with an embodiment ofthe invention.

[0054]FIG. 24 is a simplified side sectional view of a surgical filedistal cutting tip with an illumination and vision system illustratingfeatures and advantages in accordance with an embodiment of theinvention.

[0055]FIG. 25 is a simplified schematic view of an arrangement of lensesof a surgical file illumination and vision system illustrating featuresand advantages in accordance with an embodiment of the invention.

[0056]FIG. 26 is a simplified schematic view of display images providedby a surgical file illumination and vision system illustrating featuresand advantages in accordance with an embodiment of the invention.

[0057]FIG. 27 is a simplified perspective view of a dual torus and driveshaft illustrating features and advantages in accordance with anembodiment of the invention.

[0058]FIG. 28 is a simplified side view of the dual torus and driveshaft of FIG. 27.

[0059]FIG. 29 is a simplified schematic view of a dual torus partialsuperposition illustrating features and advantages in accordance with anembodiment of the invention.

[0060]FIG. 30 is a simplified schematic graphical representation ofvariation in outer rim thickness of a dual torus or toroid illustratingfeatures and advantages in accordance with an embodiment of theinvention.

[0061]FIG. 31A is a simplified sectional view along line 31-31 of FIG.28 illustrating features and advantages in accordance with an embodimentof the invention.

[0062]FIG. 31B is a simplified sectional view along line 31-31 of FIG.28 illustrating features and advantages in accordance with anotherembodiment of the invention.

[0063]FIG. 31C is a simplified sectional view along line 31-31 of FIG.28 illustrating features and advantages in accordance with yet anotherembodiment of the invention.

[0064]FIG. 32 is a simplified perspective view of a distal cutting bladeand a reciprocating slide plate that connects to the blade illustratingfeatures and advantages in accordance with an embodiment of theinvention.

[0065]FIG. 33 is a simplified schematic side view of a distal cuttingblade connected to a slide blade illustrating features and advantages inaccordance with an embodiment of the invention.

[0066]FIG. 34 is a simplified schematic view of toroid drive andassociated bearings illustrating features and advantages in accordancewith an embodiment of the invention.

[0067]FIG. 35 is a simplified schematic view of toroid drive andassociated bearings illustrating features and advantages in accordancewith another embodiment of the invention.

[0068]FIG. 36 is a simplified perspective view of a surgical filetransmission system in a test set-up illustrating features andadvantages in accordance with an embodiment of the invention.

[0069]FIG. 37 is a simplified side cross-sectional view of a surgicalfile pulsatile pump system illustrating features and advantages inaccordance with an embodiment of the invention.

[0070]FIG. 38 is a simplified side cross-sectional view of a surgicalfile pulsatile pump system illustrating features and advantages inaccordance with another embodiment of the invention.

[0071]FIG. 39 is a simplified exploded perspective view of a surgicalfile powered handpiece illustrating features and advantages inaccordance with another embodiment of the invention.

[0072]FIG. 40A is a simplified sectional view along line 40-40 of FIG.39 illustrating features and advantages in accordance with an embodimentof the invention.

[0073]FIG. 40B is a simplified sectional view along line 40-40 of FIG.39 illustrating features and advantages in accordance with anotherembodiment of the invention.

[0074]FIG. 40C is a simplified sectional view along line 40-40 of FIG.39 illustrating features and advantages in accordance with yet anotherembodiment of the invention.

[0075]FIG. 41 is a simplified schematic view of a bone and/or tissueremoval procedure illustrating features and advantages in accordancewith an embodiment of the invention.

[0076]FIG. 42 is a simplified perspective view of a bone and/or tissueremoval procedure on a plastic anatomical model of the human spineillustrating features and advantages in accordance with an embodiment ofthe invention.

[0077]FIG. 43 simplified side view of a orthopaedic surgical fileinstrument illustrating features and advantages in accordance with anembodiment of the invention.

[0078]FIG. 44 is a simplified front view of a distal cutting assembly ofthe surgical file instrument of FIG. 43.

[0079]FIG. 45 is a simplified bottom view of the distal cutting assemblyof FIG. 44.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0080] The preferred embodiments of the invention described hereinrelate generally to systems and methods for tissue cutting and removaland, in particular, to a shielded reciprocating surgical file system forcutting, removing, shaping and sculpturing bone and/or tissue materialunder direct vision.

[0081] While the description sets forth various embodiment specificdetails, it will be appreciated that the description is illustrativeonly and should not be construed in any way as limiting the invention.Furthermore, various applications of the invention, and modificationsthereto, which may occur to those who are skilled in the art, are alsoencompassed by the general concepts described herein.

[0082]FIGS. 1 and 2 show a surgical file system 10 generally comprisinga motorized reciprocating shielded surgical file instrument, apparatus,assembly or device 12 and a mobile portable control system 14 connectedvia a flexible umbilical cable 16. The surgical file device 12 generallycomprises a distal tip assembly 18 and a powered handpiece 20.Reciprocating as used herein generally includes back and forth motionand to and from motion.

[0083] The system 14 generally comprises a mobile portable stand,cabinet or trolley 22 that supports a controller or control unit or box24 and a computer system 26. In on embodiment, the system 14 has afootprint of about 0.2 m² (2 square feet (ft²)) and a height of about1.8 m (6 feet (ft)). In modified embodiments, other suitable dimensionsmay be efficaciously used, as needed or desired. The system 14 may alsoutilize wireless communication.

[0084] The cabinet 22 has a plurality of drawers or compartments 28 tostore system parts, including spare parts, such as cables, connectionlines, powered hand piece 20 and an array of various disposable distalcutting tip assemblies, for example, for neurosurgery, orthopaedicsurgery and plastic surgery. The storage drawers 28 also serve to storeinstructions.

[0085] The cabinet 22 has a plurality of wheels 30 such as caster wheelsto enable movement of the system 14. In the illustrated embodiment, thecabinet 22 has four wheels 30. The caster wheels 30 have wheel locks orother suitable fastening mechanisms to enable stationarily locking theunit at the desired position in the operating room or other area.

[0086] The computer system 26 comprises a central processing unit (CPU)32, a monitor 34, a keyboard 36 including a mouse and a color printer toproduce color pictures. The CPU 32 may be supported on (see, forexample, FIG. 1) or within (see, for example, FIG. 2) the movablecabinet 22. The CPU 32 includes a video processing system, such as butnot limited to a data acquisition board and the like, to process videosignals from the surgical file device 12 and supply the signals to themonitor or video display 34. The CPU 32 has a printer port to interfaceit with the color printer.

[0087] The display monitor 34 can comprise any one of a number ofsuitable commercially available monitors. In one embodiment, the display34 is a 17-inch (43 cm) liquid crystal display (LCD) monitor.

[0088] The storage cabinet 22 includes a substantially vertical pole orrod 38 to support the monitor 34. The height and tilt angle of thedisplay 34 is adjustable to allow suitable viewing for the operatingsurgeons. In one embodiment, the monitor 34 is positioned at a height ofabout 1.5 meters (5 feet). As discussed further below, the monitor 34can display a magnified visual picture of the view from the distal endof the cutting tip assembly 18.

[0089] The cabinet 22 includes one or more hooks or supports 42 formounting of an irrigation fluid bag, container or pouch 44. The hooks 42can be positioned at a suitable position, for example, on the pole 38.The irrigation bag 44 is provided sterile irrigation water from a source46 through a feedline 48. The sterile water is transported to the distalcutting tip assembly 18 during device operation through feed line 50.

[0090] In one embodiment, sterile water is provided to the distalcutting tip assembly 18 through the control unit 24 via feedline 50 a.In a modified embodiment, the sterile water is provided directly to thedistal cutting tip assembly 18 via feedline 50 b.

[0091] The control unit 24 is supported at a suitable working height bythe cabinet structure 22. The control unit 24 is operatively interfacedor connected the cable 16 at its proximal end 40. In the illustratedembodiment, the cable 16 connects to a front face 52 of the control box24. The control box 24 and the CPU 32 can be housed in a single unit.

[0092] The control unit 24 and the computer system 26 are powered by aconventional 115-Volt AC electrical power supply 54, for example, byconnecting a male plug to a wall receptacle. In modified embodiments,the system may be powered by a portable power supply such as a generatorand the like.

[0093] In one embodiment, the control unit 24 connects to a pressurizedgas or air source supply 56 via feedline 58. As discussed further below,the pressurized gas is used to power an air turbine motor of the poweredhandpiece 20. The pressurized gas is supplied by the hospital or housesupply. In modified embodiments, a portable pressurized gas source sucha cylinder may be efficaciously used, as needed or desired.

[0094] In one embodiment, the pressurized gas and the irrigation waterare supplied from the control unit 24 and through the umbilical cable 16to the surgical file device 12. In addition, the cable 16 provides videosignals from the surgical file device 12 to the control unit 24 andcomputer system 26. The umbilical cable 16 provides a mechanical andwaterproof connection for electrical, video, pressurized gas andirrigation water supply. In modified embodiments, one or more of theelectrical and video signals, gas and water may be transmitted throughseparate cables with efficacy, as needed or desired.

[0095] The cable 16 can be any suitable length, for example, about 16feet long. The cable 16 is sterilizable. The cable 16 may also be usedto provide a suction line, as needed or desired.

[0096] The control box 24 houses switches and valves to control the flowof the pressurized gas and irrigation water. The control unit 24 haselectrical controls for the handpiece 20 and video signals for thecomputer system 26. The control unit 24 may also include sensors such aspressure sensors, flow rate sensors and the like to monitor the flow ofthe pressurized gas and irrigation water.

[0097] Software is provided that interfaces with the control unit 24 tomonitor and control system operation and perform various other relatedfunctions. For example, the software allows the operating room personnelto enter the patient identification and date and other pertinent datainto the computer for record reference.

[0098] The software also allows operating room personnel to change videopicture zoom ratios and to control and modify details of the picture forclarity. The computer based system enables the operating personnel tosave pictures of the patient's anatomy, including before and afterpictures, to a computer file and to print out color pictures in seconds.

[0099] The software is used to control the pressurized gas andirrigation liquid flow to the surgical file device 12. The software canalso be used to turn the device 12 on and off and control the frequencyof cutting blade reciprocation during filing procedures.

[0100] The control unit 24 accommodates connection to existingcauterizing equipment. As discussed further below, and as shown inphantom in FIG. 1, the control unit 24 can be connected to a cauterizingsystem 60 through connection line 61 to stop or prevent undesirablebleeding during surgery.

[0101] In brief, to enable the surgeon to stop the bleeding of freshlycut bone tissue, the cutting blade surface can feature an electricallyconductive surface that is operatively connected to an electric circuit,for example, 60. This allows a controlled pulse of electricity togenerate a small amount of heat applied directly onto the bone surfaceto coagulate the blood and stop the bleeding at the freshly cut bonesurface only, while insulating delicate nerve roots from unwanted heatdamage. The irrigation water also works in conjunction to assist inkeeping heat precisely localized and preventing heat injury to thenearby delicate nerve roots and spinal cord.

[0102]FIG. 3 shows the surgical file device 12 with a distal tipassembly 18 having a generally curved and/or angled configuration. FIG.4 shows the surgical file device 12 with a distal tip assembly 18′having a generally straight configuration. The powered handpiece 20 hasat its proximal end 62 a quick connect docking feature 64 to enableconnection to the umbilical cable 16 that provides a mechanical andwaterproof connection for electrical, pressurized gas and irrigationwater supply.

[0103]FIG. 5 shows the surgical file device 12 connected to theumbilical cable 16 at its distal end 66. The interface or connectionbetween a proximal end 330 of the powered handpiece 18 and the cable 16includes a cover or housing 68. In the illustrated embodiment, the cover68 is generally frusto-conical in shape, though in modified embodimentsother suitable shapes such as cylindrical and the like may beefficaciously utilized, as needed or desired.

[0104] The distal tip assembly 18 at its proximal portion or end 70includes a cover or housing 72. In the illustrated embodiment, the cover72 is generally frusto-conical in shape, though in modified embodimentsother suitable shapes such as cylindrical and the like may beefficaciously utilized, as needed or desired.

[0105] The powered handpiece 20 includes a cover 74 intermediate thefront and back covers 68 and 72. In the illustrated embodiment, thecover 74 is generally cylindrical in shape and can include alongitudinally extending bulging portion 76 for housing a video camera.In other embodiments, the cover 74 may be efficaciously contoured insuitable ergonomic shapes that facilitate operation by a surgeon orother operator.

[0106] The covers 68, 72, 74 can be formed from a number of suitablydurable materials. In one embodiment, the covers 68, 72, 74 are formedfrom a suitable plastic such as a thermoplastic. In another embodiment,the covers 68, 72, 74 are formed from a suitable metal such as stainlesssteel. In modified embodiments, other suitable plastics, metals, alloys,ceramics, combinations thereof, among others, may be efficaciouslyutilized, as needed or desired. Suitable surface coatings or finishesmay be applied, as required or desired.

[0107] The covers 68, 72, 74 can be fabricated by using a number ofmanufacturing techniques. These include, but are not limited to,molding, machining, casting, forging, laser cutting and/or processing,laminating, adhesively fixing, welding, combinations thereof, amongothers, with efficacy, as needed or desired.

[0108]FIG. 6 shows a partially exploded view of the surgical file device12. As discussed further below, the powered handpiece 20 includes avideo camera 78 and a micro-motor 80 that provides rotary motion whichis converted to linear reciprocating motion within the distal tipassembly 18. FIG. 7 shows another perspective view of the surgical filedevice 12 with the distal cover 72 removed illustrating some of thefeatures of the distal tip assembly.

[0109] Distal Tip Assembly

[0110]FIGS. 8 and 9 show the distal tip assembly 18 in greater detail.In one embodiment, the composite tip 18 has a length of about 10 cm (4inches) to about 15 cm (6 inches), including all values and sub-rangestherebetween. In one embodiment, the composite tip 18 has a length ofabout 5 cm (2 inches) to about 30 cm (12 inches), including all valuesand sub-ranges therebetween. In modified embodiments, other suitablelengths may be efficaciously utilized, as needed or desired.

[0111] The distal tip assembly 18 is sterile to maintain appropriatesurgical standards and is provided in a sterile packaging. In oneembodiment, the distal tip assembly 18 is for one time use and isdisposable thereafter. As described further below, embodiments of thedistal tip assembly 18 include a cartilage or other tissue and boneremoval file with vision, illumination, irrigation and cauterizationfeatures.

[0112] The distal tip assembly 18 generally comprises a distal tipportion 92 that has a distal-most end 94 and a proximal portionextending into the cover 72 that encloses a housing 96 that receives atoroidal power converter system 98 and a water pump system. The distaltip assembly 18 further includes an interface member 102 and a coupling104 that facilitate connection between the distal tip assembly 18 andthe powered handpiece 20.

[0113] The distal tip portion 92 generally comprises a reciprocatingcutting or filing blade 106 that is enclosed in a protective case orshield 108. The shield 108 has an aperture, window, opening 112 toexpose a cutting surface 114 of the filing blade 106 proximate thedistal end 94. Desirably, the shielded blade 106 permits surgical boneand/or tissue removal substantially without risk of damage to nearbydelicate tissues such as nerve tissue.

[0114] The distal tip portion 92 can be configured to be small and thinso it is minimally intrusive and can go around corners and into anysmall inaccessible blind channels where nerves are located. The distaltip portion 92 can be configured to fit any desired cavity or contouredshape. The tip portion 92 can be supplied in a variety of sizes andshapes to suit a particular application such as, but not limited to,neurosurgery, orthopaedic surgery and plastic surgery.

[0115] The blade cutting surface 114 can be located on the end of anextension with a bend 116 of any desired angle. In the illustratedembodiment of FIGS. 8 and 9, the tip portion 92 has a curved, angled orbent configuration with the bend 116. In another embodiment, the distaltip portion 92 has a substantially straight and/or planar (flat)configuration.

[0116] The tip portion 92 further includes a linear bearing retainer 118within the shield 108. The reciprocating blade 106 is precision fittedwithin the bearing retainer 118 that allows free linear motion of thereciprocation blade stroke. Advantageously, the bearing retainer 118provides low friction bearing surfaces for the reciprocating motion ofthe blade 106.

[0117] The bearing retainer 118 comprises a plurality of stationarylinear bearings 120 which are positioned on the top, bottom and bothsides of the reciprocation blade. The top linear bearing 120 has anaperture, opening or window 122 that is substantially aligned with theshield aperture 112 to expose the blade cutting surface 114. In oneembodiment, the tip portion 92 (and hence the lengths of the bladecutting surface 114 and the apertures 112, 122) are configured so thatsubstantially the entire blade cutting surface 114 is exposed during thefull blade reciprocation cycle.

[0118] The bearing retainer 118 can be formed from a number of suitablydurable materials. In one embodiment, the bearing retainer 118 is formedfrom a suitable plastic such as a thermoplastic. In modifiedembodiments, other suitable plastics, metals, alloys, ceramics,combinations thereof, among others, may be efficaciously utilized, asneeded or desired. Suitable surface coatings or finishes may be applied,as required or desired.

[0119] The bearing retainer 118 can be fabricated by using a number ofmanufacturing techniques. These include, but are not limited to,molding, machining, casting, forging, laser cutting and/or processing,laminating, adhesively fixing, welding, combinations thereof, amongothers, with efficacy, as needed or desired.

[0120] As described in more detail below, the distal tip portion 92further includes a pair of fiber optic probes 124, 126 that are part ofan on-board optical illumination and vision system. The fiber opticprobes 124, 126 optically connect or interface at their proximal ends tothe video camera 78.

[0121] The bottom or lower fiber optic probe 124 is below the lowerbearing 120. The fiber optic probe 124 may be housed within the shield108 or it may have its independent protective jacket below the shield108. The fiber optic probe 124 has a distal end 128 at about thedistal-most end 94 of the tip portion 92.

[0122] The top or lower fiber optic probe 126 is above the upper bearing120. The fiber optic probe 126 may be housed within the shield 108 or itmay have its independent protective jacket above the shield 108. Thefiber optic probe 126 has a distal end 130 proximal to a proximal end132 of the aperture 112 and/or the cutting surface 114.

[0123] The shield 108 can include the aperture 112 on any one of itssides depending on the positioning of the cutting surface 114. Thisincludes the top (as shown in, for example, FIGS. 8 and 9), the bottomand the sides of the shield 108 and even its distal end 134. The shield108 has a longitudinally extending cavity that houses the blade 106, thebearing retainer 118 and in some embodiments the fiber optic probes 124,126. In the illustrated embodiment, the distal end 134 closes thelongitudinal shield cavity.

[0124] In one embodiment, the shield 108 is capable of deflecting andbends at predetermined and/or low loads (for example about 2 lbs.) inorder to prevent injury or damage to tissue, such as nerve tissue,engaged by the shield 108. The shield 108 has a predeterminedstress-strain curve and spring constant to provide the desireddeflection and can comprise, for example, a suitable polymer and thelike. The shield 108 may bend at the bend location 116 or at a locationproximate to the contact with the tissue. One or more of the associatedtip portion 92 components such as the blade 106, bearings 120 and thefiber optic probes 124, 126 can also bend with the shield 108, as neededor desired.

[0125] The shield 108 can be formed from a number of suitably durablematerials. In one embodiment, the shield 108 is formed from a suitableplastic such as a thermoplastic. In another embodiment, the shield 108is formed from a polymer that is flexible or can bend under apredetermined load. In modified embodiments, other suitable plastics,metals, alloys, ceramics, combinations thereof, among others, may beefficaciously utilized, as needed or desired. Suitable surface coatingsor finishes may be applied, as required or desired.

[0126] The shield 108 can be fabricated by using a number ofmanufacturing techniques. These include, but are not limited to,molding, machining, casting, forging, laser cutting and/or processing,laminating, adhesively fixing, welding, combinations thereof, amongothers, with efficacy, as needed or desired.

[0127] The shield 108, the bearing retainer 118 and the fiber opticprobes 124, 126 generally conform in shape to the longitudinal profileof the blade 106. In the illustrated embodiment of FIGS. 8 and 9, thisis a curved, angled or bent profile with a bend at around 116.

[0128]FIG. 10 shows a cross-sectional view of the distal tip portion 92at a location proximal to the aperture 112 and the bend 116. The blade106 is substantially centrally located within the shield or outer jacket108. The blade 106 is precision fitted within the bearing retainer 118including the linear bearings 120. The respective lower and upper fiberoptic probes 124, 126 are buffered from the blade 106 by the stationarybearings 120.

[0129] The cutting blade linear bearing 120 has a series of shallowslots 190 running substantially longitudinally in line with the proximalto distal axis. The slots 190 serve as water passageways to enableirrigation water to be transported from a proximal to a distal location.The irrigation water serves several functions and provides severaladvantages.

[0130] The water is a lubricant for the interface between the movingblade 106 and the stationary linear bearings 120, which in oneembodiment are positioned on the top and bottom and both sides of thereciprocation blade 106. The water cools the blade and bearing material,and in the embodiment the bearing material is plastic, prevents theplastic bearing material from getting hot and softening. The water alsoserves to wet the cutting blade surface. The water is also used to cleantissue and transport the cut tissue away from the cutting blade 106.Additionally, water transported across the linear blade 106 intimatelyirrigates the volume of water in the distal blade area to clear theoptical vision field for clear viewing.

[0131]FIG. 11 shows a cross-sectional view of the distal tip portion 92at the shield aperture 112. The cutting surface 114 of the blade 106 isexposed and is above the lower bearing 120, the lower fiber optic probe124 and a lower portion 192 of the shield 108. The drawing also showsportions of the shield 108 and the upper bearing 120 at the tip distalend 94. In this embodiment, the cross-sectional profile of the cuttingsurface 114 is convex and the associated portions of the shield 108,bearings 120 and lower fiber optic probe 124 generally conform to thisshape.

[0132] In one embodiment, and as described further below, the toroidaldrive system 98 is substantially mounted within the housing 96 andgenerally comprises a rotatable toroid drive 136 and a drive slide 138.A drive shaft 140 is connected to the handpiece motor 80 and transfersrotary motion to the toroid drive 136 which engages the linear slider138 to convert rotary motion into reciprocating motion that is providedto the blade 106 for performing bone and/or tissue removal operations.In modified embodiments, other suitable rotary to reciprocating motionmechanisms or devices may be used, as needed or desired, toreciprocatingly drive the blade 106.

[0133] As discussed further below, the drive shaft 140 is connected tothe toroid drive 136 and has a specially designed female receptor hole.The receptor hole allows the drive shaft 140 to substantiallyirrotationally mate with a power drive shaft of the motor 80.

[0134] The housing 96 has a distal end 142 and a proximal end 144 and agenerally flat recessed surface 146 extending from the distal end 142towards the proximal end 144. The linear slide 138 is reciprocatinglyseated on or within the recessed surface 146. The housing 96 includes acavity 148 intermediate the recessed surface 146 and the housingproximal end 144 that receives the rotatable toroid drive 136. Thehousing proximal end 144 has an opening 149 that receives a power shaftof the handpiece motor 80 that connects to the drive shaft 140.

[0135] The housing 96 can be formed from a number of suitably durablematerials. In one embodiment, the housing 96 is formed from a suitableplastic such as a thermoplastic. In modified embodiments, other suitableplastics, metals, alloys, ceramics, combinations thereof, among others,may be efficaciously utilized, as needed or desired. Suitable surfacecoatings or finishes may be applied, as required or desired.

[0136] The housing 96 can be fabricated by using a number ofmanufacturing techniques. These include, but are not limited to,molding, machining, casting, forging, laser cutting and/or processing,laminating, adhesively fixing, welding, combinations thereof, amongothers, with efficacy, as needed or desired. The housing 96 and bearingretainer 118 may comprise an integral unit, for example, they may beformed by molding and the like.

[0137] The toroid drive 136 is connected with the drive shaft 140. Thetoroid drive 136 has an outer rim 150 that is engaged with the slider138 and transmits rotary motion that is converted into reciprocatingmotion by the slider 138.

[0138] The slide plate 138 has a distal end 152, a proximal end 154 anda specially contoured slot 156 proximate to the proximal end 152 with apair of generally opposed bearing surfaces 164, 166. As described ingreater detail below, the slot 156 receives the rotating outer rim 150of the toroid drive 136.

[0139] The blade 106 is connected to the slide 138. As described ingreater detail below, this connection utilizes shear pins to provide asafety mechanism against blade buckling.

[0140] The slide 138 can be formed from a number of suitably durablematerials. In one embodiment, the slide 138 is formed from a suitableplastic such as a thermoplastic. In modified embodiments, other suitableplastics, metals, alloys, ceramics, combinations thereof, among others,may be efficaciously utilized, as needed or desired. Suitable surfacecoatings or finishes may be applied, as required or desired.

[0141] The slide 138 can be fabricated by using a number ofmanufacturing techniques. These include, but are not limited to,molding, machining, casting, forging, laser cutting and/or processing,laminating, adhesively fixing, welding, combinations thereof, amongothers, with efficacy, as needed or desired.

[0142] The interface member 102 has an opening 158 which allows passageof the fiber optic probes 124, 126 for connection to the camera 78. Theinterface member 102 has an opening 160 that receives that receives apower shaft of the handpiece motor 80 that connects to the drive shaft140.

[0143] The coupling 104 has an opening 162 that receives that receives apower shaft of the handpiece motor 80 that connects to the drive shaft140. The openings 149, 160 and 162 are substantially aligned with oneanother.

[0144] The interface member 102 and coupling 104 can be formed from anumber of suitably durable materials. In one embodiment, the interfacemember 102 and coupling 104 are formed from a suitable plastic such as athermoplastic. In modified embodiments, other suitable plastics, metals,alloys, ceramics, combinations thereof, among others, may beefficaciously utilized, as needed or desired. Suitable surface coatingsor finishes may be applied, as required or desired.

[0145] The interface member 102 and coupling 104 can be fabricated byusing a number of manufacturing techniques. These include, but are notlimited to, molding, machining, casting, forging, laser cutting and/orprocessing, laminating, adhesively fixing, welding, combinationsthereof, among others, with efficacy, as needed or desired.

Blade Embodiments

[0146] Embodiments of the invention provide reciprocating cutting bladefor precision bone and/or tissue removal. In one embodiment, thereciprocating cutting blade is shielded or covered or guarded on fivesides to provide a shielded surgical file.

[0147] The shielded file can be flat, planar, convex or concave in itscross-section. The shielded file can extend generally straight or becurved, angled or bent along its longitudinal axis. Advantageously, theangled configuration allows the cutting surface to travel around acorner to reach into usually inaccessible body cavities. Desirably, thisprovides the ability to remove unwanted tissue in a blind tunnel or bodycavity while enabling direct vision through the illumination and visionprobes.

[0148] The shielded file can be dimensioned in a number of manners. Theshielded file can be any length or width suitable for the human ormammalian anatomy proportions. For other non-medical applications, theshielded file can be of any length or width to suit the material removalapplication.

[0149] The thickness of the shielded file can be varied to be very thin.In one embodiment, the thickness can be of the order of {fraction(1/10)}^(th) of an inch. Advantageously, this enables the shielded fileto fit into small spaces such as between a nerve and the foramen openingthat it is passing through. In other embodiments, the thickness of theshielded file can be greater, as needed or desired.

[0150] The cutting blade can be shaped and contoured in severalconfigurations. In one embodiment, the reciprocating cutting blade isstraight and planer (in one flat plane). In another embodiment, thereciprocating cutting blade that is curved convex or concave in itscross sectional shape. In yet another embodiment, the reciprocatingcutting blade that is substantially straight in its longitudinal axis.In still another embodiment, the reciprocating cutting blade is curvedin its longitudinal axis.

[0151] The thickness of the cutting blade drive 106 can be varied. Inone embodiment, the cutting blade thickness is in the range from about100 microns or μm (0.004 inches) to about 300 μm (0.012 inches). Inanother embodiment, the cutting blade thickness is in the range fromabout 50 μm (0.002 inches) to about 600 μm (0.024 inches). In yetanother embodiment, the cutting blade thickness is in the range fromabout 25 μm (0.001 inches) to about 2.5 mm (0.1 inches). In modifiedembodiments, other suitable dimensions may be efficaciously utilized, asneeded or desired.

[0152] The cutting blade 106 can be formed from a number of suitablydurable materials. In one embodiment, the cutting blade 106 is formedfrom steel. In another embodiment, the cutting blade 106 comprisesspring stainless steel. In modified embodiments, other suitable metals,alloys, plastics, ceramics, combinations thereof, among others, may beefficaciously utilized, as needed or desired. Suitable surface coatingsor finishes may be applied, as required or desired.

[0153] The cutting blade 106 can be fabricated by using a number ofmanufacturing techniques. These include, but are not limited to,molding, machining, casting, forging, laser cutting and/or processing,laminating, adhesively fixing, welding, combinations thereof, amongothers, with efficacy, as needed or desired.

[0154] In one embodiment, the cutting blade 106 is flexible.Advantageously, this allows the cutting blade to be easily bent, angledor curved along its length as it is enclosed in a bent, angled or curvedouter shield 108. In another embodiment, the cutting blade issubstantially rigid. This can be suitable for blade configurations thatare generally straight. The rigid blade may also be bent by suitabletechniques, as needed or desired. In modified embodiments, the cuttingblade 106 may efficaciously comprise one or more flexible portions andone or more rigid portions, as needed or desired.

[0155]FIG. 12 shows an embodiment of the cutting blade 106. The blade106 comprises a thin flexible material that is capable of bending alongits length. The blade 106 includes a distal section or portion 194 withthe cutting surface 114, a medial section or portion 196 and a proximalsection or portion 198. When enclosed within the curved, angled or bentshield 108 the blade 106 flexes like a thin spring to conform to theshape of the shield or guide cover 108. Thus, the medial section 196 iscurved, angled or bent while the respective distal and proximal sections194, 198 extend generally straight.

[0156]FIG. 13 shows a cross-section of a cutting surface 114 a and anassociated portion 202 a of the shield 108 a having a generally convexconfiguration suited for some particular bone and/or tissue removalapplications. The convex curvature of the cutting surface 114 a can alsobe advantageous in providing enhanced rigidity to the thin cuttingsurface 114 a and/or the associated blade 106.

[0157]FIG. 14 shows a cross-section of a cutting surface 114 b and anassociated portion 202 b of the shield 108 b having a generally concaveconfiguration suited for particular bone and/or tissue removalapplications. The concave curvature of the cutting surface 114 b canalso be advantageous in providing enhanced rigidity to the thin cuttingsurface 114 b and/or the associated blade 106.

[0158]FIG. 15 shows a lengthwise-section of the distal tip portion 92having a cutting surface 114 c on the top or upper side of thereciprocating blade 106 within the non-moving shield 108. Thisconfiguration is suited for some particular bone and/or tissue removalapplications. The bend 116 allows the cutting surface 114 c to pass intoa cavity that involves traveling around a corner. The direction of bladetravel is generally denoted by arrows 204.

[0159]FIG. 16 shows a lengthwise-section of the distal tip portion 92having a cutting surface 114 d on the bottom or lower side of thereciprocating blade 106 within the non-moving shield 108. Thisconfiguration is suited for some particular bone and/or tissue removalapplications. The bend 116 allows the cutting surface 114 d to pass intoa cavity that involves traveling around a corner. The direction of bladetravel is generally denoted by arrows 204.

[0160]FIG. 17 shows the cutting surface 114 including an abrasivematerial or abrasives 206 for cutting, removing, filing or grinding boneand/or tissue materials. For clarity, one side of the shield 108 hasbeen removed in the drawing. Any one of a number of suitable abrasivesmay be used that are safe to use within a patient's body or arebiocompatible and hard. In one embodiment, the abrasives 206 compriseembedded diamonds or diamond particles.

[0161] Also shown in FIG. 17 is a lateral slot or opening at the tipportion distal end 94. Advantageously, the distal opening 208 allows theremoval of any bone and/or tissue debris that may collect within thedistal and provides for flushing out of the debris as the blade cuttingsurface 114 reciprocates and the irrigation fluid flows out of theinstrument.

[0162]FIG. 18 shows the blade cutting surface 114 including a pluralityof micro holes or openings 212 for the flow of irrigation fluidtherethrough. For clarity the abrasives are not shown in the drawing.The holes 212 are in fluid, liquid or hydraulic communication with thelongitudinal slots 190 of the lower linear bearing 120. The slots 190 ofthe upper linear bearing 120 also provide irrigation water to thecutting area.

[0163]FIG. 19 schematically depicts the fluid, liquid or hydrauliccommunication between the bearing slot(s) 190 and the cutting surfaceholes 212. The flow of water from the bearing slots(s) 190 and the microhole openings 212 is generally indicated by arrows 214. The water isforced to flow up, down or out through the openings 212 in the cuttingblade surface 114 and away from the blade cutting surface 114. The waterwashes away cut material and keeps debris from clogging the cuttingsurface 114 to maintain optimum cutting and material removalperformance, and to keep the cutting area cool to prevent tissuenecrosis damage.

[0164] The water also flows over the moving (reciprocating) cuttingblade 106 and drive mechanism or bearings 120 to provide cooling andlubrication. The water can be forced into the cutting cavity 112 toflush away micro cutting debris and maintain a clear field of view forvideo navigation and visualization. The water can be forced into thecutting area cavity 112 to clean and remove freshly cut bone cells andbone fragments to prevent repopulation and unwanted bone growth in thearea.

[0165]FIG. 20 is another schematic depiction showing the fluid, liquidor hydraulic communication between the irrigation fluid holes 212 andthe bearing irrigation passageways 190. The drawing also shows theabrasive material or abrasives 206 of the blade cutting surface 114.

[0166]FIG. 21 shows the reciprocation blade stroke direction asgenerally indicated by arrows 216. The free linear motion of thereciprocation blade stroke is a linear stroke. In one embodiment, forapplications within the human body, the linear stroke is in the rangefrom about 2.5 mm (0.1 inches) to about 7.6 mm (0.3 inches), includingall values and sub-ranges therebetween. In another embodiment, thelinear stroke is in the range from about 1.3 mm (0.05 inches) to about12.7 mm (0.5 inches), including all values and sub-ranges therebetween.In yet another embodiment, the linear stroke is in the range from about0.25 mm (0.01 inches) to about 25.4 mm (1 inch), including all valuesand sub-ranges therebetween. In modified embodiments, the linear strokemay efficaciously be lower or higher depending on the particularapplication, as needed or desired.

Cauterization

[0167] In accordance with one embodiment, the surgical file instrument12 can stop the small amount of bleeding of freshly cut or sculptureshaped bone or other tissue by accommodating connection to existingcauterizing equipment 60. In this embodiment, the special feature thesystem has is a non-electrically conductive shield 108, which iscovering an electrically conductive metal file blade 106.

[0168] When bleeding of the freshly cut bone is detected, the filecutting blade 106 can be brought back into contact with the freshlyshaped bone that may be bleeding slightly. A pulse of electricity can bemomentarily applied that will flow from the metal blade file surfaceinto the bleeding bone or other tissue surfaces. This will heat thebleeding bone or other tissue surfaces, coagulate the blood flow andadvantageously stop the bleeding of the bone and/or tissue surface.Desirably, the irrigation flow facilitates localizing the heat andcooling while the shield 108 protects the adjacent nerves and spine fromheat.

Illumination and Vision Probes

[0169]FIG. 22 shows a fiber optic vision system 218 including the fiberoptic probes 124 and 126. The fiber optic vision system 218, in somesurgical embodiments, enables surgeons to visually see and verify thepresence of unwanted bone and cartilage buildup that is causing nerveroot compression and damage to normal body functions. This informationon the unwanted material can be documented and recorded by saving visualpictures into a computer database and printing color picturesimmediately for reference and record.

[0170] The lower fiber optic probe 124 includes a plurality of opticalfibers 220 a that optically terminates at a distal lens array orarrangement 222 a. The lens array 222 a is positioned at substantiallythe tip distal end 94. The fiber optic probe 124 may be placed withinthe shield 108 or it may have a separate housing. The lower fiber opticprobe 124 generally follows the longitudinal profile of the distal tipportion 92, the blade 106 and/or the shield 108.

[0171] The upper fiber optic probe 126 includes a plurality of opticalfibers 220 b that optically terminates at a distal lens array orarrangement 222 b. The lens array 222 b is positioned proximal to theblade cutting surface 114. The fiber optic probe 126 may be placedwithin the shield 108 or it may have a separate housing. The upper fiberoptic probe 126 generally follows the longitudinal profile of the distaltip portion 92, the blade 106 and/or the shield 108.

[0172] Advantageously, the fiber optic vision system 218 enables visualviewing of the patients body cavities all during insertion and placementof the cutting blade. This is intended to enable the surgeon to safelynavigate the tiny body cavities such as neuroforamen tubular canal andavoid damage to fragile nerve roots.

[0173]FIG. 23 shows the optical fibers 220 a in more detail. The upperoptical fibers 220 b (220 b′, 220 b″) have a similar configuration andfunctioning though they may have a different curvature or be flat andplanar. The optical fibers 220 a comprise a central plurality of opticalvision fibers 220 a′ flanked by light or illumination fibers 220 a″. Theoptical vision fibers 220 a′ are connected at their proximal end to thevideo camera 78.

[0174] The fiber optical illumination fibers 220 a″ illuminate the bodycavity and enable video visualization. An LED located at the proximalend of the fiber optics illumination fibers 220 a″ is used transmitlight to the distal end of the illumination fibers 220 a″ to provideilluminating light. Advantageously, the direct vision optical system 218enables surgeons to safely navigate into blind cavities of the humanbody and to illuminate and see specific body anatomy such as nerves andbony buildups that could be irritating and pressing against nervescausing nerve compression.

[0175] In the illustrated embodiment, the direct vision optical system218 desirably provides an integrated illumination and optical visionsystem. The optics for vision and illumination are included within thedistal tip assembly 18 which in some embodiments is a docking sterileone time use assembly.

[0176] Referring in particular to FIG. 24, the distal optical systemlenses arrangements 222 a and 222 b are each arrayed in three segments.The lower optical segments 222 a are arranged with a video imaging lens222 a′ centered medially and with illuminating lenses 222 a″ positionedon the right and left lateral sides. The upper optical segments 222 bare arranged with a video imaging lens 222 b′ centered medially and withilluminating lenses 222 b″ positioned on the right and left lateralsides.

[0177]FIG. 25 shows the lens arrays 222 a, 222 b in more detail. Thelateral sides of the central lenses 222 a′, 222 b′ have a respectivesemi-arc male shape 224 a′, 224 b′ to each of their left and rightsides. The illuminating lenses 222 a″, 222 b″ are shaped to have matingfemale semi-arc medial sides 226 a″, 226 b″ on there medial sides whichmate into the male mating features 224 a′, 224 b′ of the central lenssides.

[0178] Advantageously, such mating lens arrays 222 a, 222 b canaccommodate a wide range of instrument sizes while using substantiallythe same basic lens assembly design. Different lenses may be used in thedesign and the curvature of the lens array adjusted and changed toprovide the desired illumination and/or field of view. For example, fora particular medial video imaging lens 222 a′, 222 b′ the curvature ofthe side illuminating lenses 222 a″, 222 b″ can be adjusted or changedto illuminate the desired field of view. This desirably saves on costsince micro lenses are very expensive to tool up and make. The distaltip assembly 18 can have numerous sizes with varying cross sections ofthe distal tip portion 92 depending on the particular application andadvantageously substantially the same basic lens assembly design 222 a,222 b can be utilized with the different sizes.

[0179] Additionally the mating lenses 222 a′, 222 b′ and 222 a″, 222 b″allow the black out of the respective mating surfaces 224 a′, 224 b′ and226 a″ and 226 b″ to substantially prevent illumination light frompassing laterally into the imaging lens 222 a′, 222 b′ and degrading theoptical quality of the resulting picture. A lens set comprising thecentral imaging lens 222 a′, 222 b′ and one each right and leftilluminating lenses 222 a″, 222 b″ can be assembled onto a wide range ofinstrument disposable cutting tips 18 in an assembly that has an opticaldistal lens system which is very thin in cross section and that thelenses follow the instrument cross sectional curve. Advantageously, forembodiments of the invention and in particular the neurosurgeryembodiments, having a very thin cross section enables the instrumentsdistal tip to fit into the tiny space between a nerve root and itsneuroforamen opening.

[0180] As shown in FIG. 26 the images from the direct vision opticalsystem 218 can be viewed on the LCD monitor 34. The drawing shows anexample of the display with a view 228 from the upper fiberoptic 126looking onto the blade 106 and a view 230 from the lower fiberoptic 124looking out from the instrument distal end 92.

Toroidal Transmission System

[0181] The toroidal transmission or power conversion system 98 is amechanical conversion device that converts rotary to reciprocatingmotion or action. The powered handpiece 20 houses a rotating motor 80 topower the cutting action of the tissue removal instrument or blade 106.The rotating mechanical action of the motor 80 is converted intoreciprocating mechanical motion of a suitable reciprocal stroke length.It is desirable that the mechanical motion conversion device be simpleand have few parts.

[0182] Having a video camera system mounted directly into areciprocating motion mechanical device can create a stability problemwith respect to inherent vibration that is usually inherent in allreciprocating motion mechanical devices. Advantageously, the toroidaldrive system 98 of embodiments of the invention provides a desirablesolution for the vibration problem since it has low or minimum levels ofassociated vibration. This advantageously provides a stable platform forthe capture of high quality pictures by the video system including thecamera 78 housed in the handpiece 20.

[0183] The toroidal drive system 98 inherently has few parts and can bebuilt to be very low vibration due to low mass of the reciprocatingcomponents. Thus, the toroidal drive system 98 can provide the poweredhandpiece 20 with a stable platform and a smooth running mechanicalaction. The transmission system of embodiments of the invention hasutility in a number of fields and applications where conversion ofrotary motion to reciprocating motion is desired.

[0184]FIGS. 27 and 28 show the toroid drive 136 and the female receptordrive shaft 140. In one embodiment, the toroid drive 136 and the driveshaft 140 comprise an integral unit and are formed as a single piece. Inanother embodiment, the toroid drive 136 and the drive shaft 140 can berigidly connected to one another.

[0185] The toroid drive 136 and the drive shaft 140 can be formed from anumber of suitably durable materials. In one embodiment, the toroiddrive 136 and the drive shaft 140 are formed from a suitable plastic bymolding. The plastic material may comprise a suitable thermoplastic. Inmodified embodiments, other suitable plastics, metals, alloys, ceramics,combinations thereof, among others, may be efficaciously utilized, asneeded or desired. Suitable surface coatings or finishes may be applied,as required or desired.

[0186] The toroid drive 136 and the drive shaft 140 can be fabricated byusing a number of manufacturing techniques. These include, but are notlimited to, molding, machining, casting, forging, laser cutting and/orprocessing, laminating, adhesively fixing, welding, combinationsthereof, among others, with efficacy, as needed or desired.

[0187] The toroid drive 136 and the drive shaft 140 are rotatable abouta substantially central rotation axis 232. The toroid drive 136 has agenerally circular or curvilinear cam portion 234 and a generallycentral shank portion 236. As discussed further below, the cam 234 has aspecially designed generally circular or curvilinear outer rim 150 witha varying or non-uniform thickness.

[0188] The cam 234 and/or the outer rim 150 have a substantially centralside view plane 238. The cam 234 and/or the outer rim 150 are tiltedrelative to a vertical plane or axis 240 by a predetermined angle α andhence to the rotation axis by an angle β where β=90°−α. Thus, typicallyβ and α are less than 90°.

[0189] In one embodiment, α is about 20° and β is about 70°. In anotherembodiment, α is in the range from about 10° to about 40° and β is inthe range from about 50° to about 80°, including all values andsub-ranges therebetween. In yet another embodiment, α is in the rangefrom about 5° to about 80° and β is in the range from about 10° to about85°, including all values and sub-ranges therebetween. In modifiedembodiments, α and β may be lower or higher, as needed or desired.

[0190] As schematically illustrated in FIG. 29, in one embodiment, thecam 234 and/or the outer rim 150 are designed to provide a variablethickness for the outer rim 150 by the partial superimposition of twotoruses or toroids 242, 244 of substantially uniform rim thickness withrespective central axes 246, 248. By controlling the degree ofsuperposition, the rim 150 of variable and controlled thickness iscreated. Thus, the transmission or power conversion system 98 is alsoreferred to as a “hybrid dual or twin toroid” system.

[0191] Advantageously, the outer rim 150 thickness is varied such thatthe rim 150 substantially continuously contacts the bearing surfaces 164and 166 as the cam 234 rotates about the central axis 232. Thus,desirably the two surfaces 164 and 166 can remain at a substantiallyfixed distance apart as they move linearly back and forth inreciprocating motion in response to the cam's rotation about the centralaxis 232.

[0192] In the illustrated embodiment, the torus central axes 246, 248are at an offset angle θ to produce the desired variable thickness rim150. The slightly dimpled or grooved surface 250 is indicative of thepartial superposition of the two toruses or toroids 242, 244. Inmodified embodiments, more than two toruses and/or toruses with variablerim thickness may be utilized to create the desired outer rim profile.

[0193] Advantageously, the dual torus or toroid (one toroid partiallyinside another) configuration provides an elegant solution of formaintaining a uniform distance between the bearing surfaces 164, 166 ordriven rollers. The rotation of the toroid or torus cam 234 moves theouter rim 150 in a reciprocating motion with the motion being generallyparallel to the rotary axis 232. The reciprocating motion of the slideplate 138 is also generally parallel to the rotary axis 232 which isthen transmitted to the blade 106.

[0194]FIG. 30 shows the thickness profile of the outer rim 150 inaccordance with one embodiment. The thickness varies across the rim 150in a generally offset sinusoidal profile with a minimum thicknessT_(min) and a maximum thickness T_(max). In modified embodiments, othersuitable rim thickness profiles may be efficaciously utilized, as neededor desired.

[0195] The disposable cutting blade assembly 18 includes the integratedtransmission system 98 within the distal cover 72. The transmissionsystem 98 converts the rotary motion of the drive motor 80 into thereciprocating motion of the tissue-cutting blade 106. The transmissionsystem 98 is a sterile assembly of the disposable cutting blade assembly18 that is sterile packaged.

[0196] The transmission system 98 is an internal mechanism and isgenerally housed within the housing 96. This is important in that the“one time use disposable” tip assembly 18 embodiments because easyseparation from the re-sterilizable motor drive portion of the poweredhandpiece 20. In theses embodiments, the powered handpiece 20 with itsrotary motor 80 comprises an independent assembly from the disposabledistal cutting tip assembly 18. Numerous sizes and shapes of distalcutting tip portion 92 are available to be connected onto the motordrive powered handpiece 20.

[0197] Since the disposable distal cutting tip assembly 18 has aninternal mechanism to convert rotary motion into reciprocating motion,it advantageously enables a simple and cost effective means ofdisconnecting the two assemblies 18 and 20. The drive shaft 140 at itsproximal end 253 includes a female receptor hole 254 that is configuredto substantially irrotationally mate with a matching male distal shaftdrive protruding out of the motor drive 80.

[0198]FIG. 31A shows a simple female triangular hole 254 a in the driveshaft 140 that can engage a triangular shaped distal shaft driveprotruding out of the motor drive assembly. When the distal tip assembly18 and the powered handpiece 20 are connected both the female triangularreceptor hole 254 a and the motor's male triangular drive shaft canrotate in tandem. The male and female features are free to mesh andalign during the axial motion of connecting the disposable cutting tipassembly 18 onto the reusable sterilizable motor handpiece 20.

[0199] A triangular shaped male mating drive is desirable because itfacilitates sterilization of the male triangular shaft. The surfacesthat are steam sterilized and reused are desirably simple surfaces thatare easy to wash and clean. The surfaces should also enable reliablecleaning prior to sterilization. A triangular male shaft has three flatsurfaces that are both easy to see and clean.

[0200] In modified embodiments, other suitable male-female mating drivepolygonal or non-polygonal interlocking configurations may be utilizedwith efficacy, as needed or desired. For example, FIG. 31B shows agenerally square or rectangular female receptor hole 254 b and FIG. 31Cshows a generally hexagonal female receptor hole 254 c.

[0201]FIGS. 32 and 33 show the cutting blade 106 and the drive slide138. The outer rim 150 of the toroid drive 136 engages the slide slot156 and abuts against the bearing surfaces 164, 166 as it rotates toreciprocatingly displace the slide 138 connected to the blade 106. Theslide 138 can be generally above the toroid drive 136 or it can begenerally below the toroid drive 136. In modified embodiments, the slide138 can be to the sides of the toroid drive 136 as long as the outer rim150 rotates within the slide slot 156 and causes the slide to move in areciprocating motion.

[0202] It is important that the distal filing blade 106 maintain itsstructural rigidity and not to fail in a buckling mode that would causethe file blade 106 to become bent or distorted into a shape that mayresult in an undesirable thicker profile. To safeguard against this, inone embodiment, a safety shear system is provided.

[0203] The slide 138 includes a pair of posts or pins 260, 262 thatengage respective blade holes 256, 258. In one embodiment, the posts260, 262 are formed from a molding process in which the slide 138including the posts 260, 262 comprises a plastic. The posts 260, 262 inone embodiment are heat staked and the like to mushroom and formrespective heads 264, 266 to affix the blade 106 and the slide 138. Themushroomed pins 260, 262 prevent undesirable blade buckling by beingconfigured to shear at a force much lower than the force that couldpotentially buckle the file blade 106.

[0204] Thus, advantageously, the file blade 106 is driven by a structurethat has an intentional weak point that will shear away the drivingreciprocating action of the blade drive 106 to prevent a potentialdistal blade 106 buckling. The configuration of the shear pins 260, 262is tailored to the specific file blade configuration (which varies inwidth and length and cross sectional curve). Thus, the shear pinconnection including the diameter and/or cross-section of the mushroomedheads 264, 266 and/or the shank portions of the pins 260, 262 isconfigured such that the mushroomed pins 260, 262 shear at a force lowerthan a force that would buckle the specific distal cutting blade 106 andallow safe disengagement and disconnection of the blade 106 from theslide 138.

[0205] Advantageously, the diameter(s) of the pins 260, 262 provides adesirable shear pin safety mechanism. The pins 260, 262 allow theconnection between the drive slide 138 and the blade 106 to shear at apredetermined force. This force can be determined for a particularcutting blade configuration by a number of methods including modeling,numerical analysis, computer simulation, experimental and empiricaltesting and the like, among others. Accordingly, each differing cuttingblade 106 is provided with a shear connection feature to shear and stopthe blade driving action before the blade could conceivably buckle. Aclearance space 268 in the slide 138 is provided in the proximaldirection behind a blade proximal end 270 to allow the blade 106 to moveproximally in the slide part 138 when shear disconnection occurs so thatthe blade 106 is substantially decoupled from the reciprocating motion.

[0206] The safety shear force F_(shear) can be calculated as a functionof the blade buckling force F_(buckle) in a number of ways to providesuitable protection. In one embodiment, the shear force F_(shear) isabout ⅓^(rd) of the blade buckle force F_(buckle). In anotherembodiment, the shear force F_(shear) is in the range from about0.25F_(buckle) to about 0.75F_(buckle), including all values andsub-ranges therebetween. In yet another embodiment, the shear forceF_(shear) is in the range from about 0.1F_(buckle) to about0.9F_(buckle), including all values and sub-ranges therebetween. Inmodified embodiments, the shear force F_(shear) may be lower or higher,as needed or desired.

[0207]FIGS. 32 and 33 illustrate a connection between the blade 106 andthe slide plate 138 in accordance with an embodiment that provides asafety shear decoupling between the 106 and the slide plate 138. Inmodified embodiments, as the skilled artisan will appreciate, the blade106 and the slide 138 may be connected utilizing other suitabletechniques, as needed or desired.

[0208]FIG. 34 shows the hybrid dual toroid drive 136 with a pair ofassociated bearings 272, 274 operatively mounted on the slide plate 138.The bearings 272, 274 and their toroid abutting surfaces 276, 278 arespaced by a predetermined distance that allows the variable thicknesscam outer rim 150 to be in substantially continuous contact whilerotating. In this embodiment, the rotation axis 232 is substantiallyperpendicular to a plane 280 between the bearing surfaces 276, 278.

[0209] The specially configured bearing abutting surfaces 282, 284 ofthe outer rim 150 advantageously provide an increased surface contactarea with respective bearing surfaces 276, 278. This desirably decreasesthe pressure load between driving toroidal surfaces 282, 284 and thedriven linear slide follower bearings 272, 274 and their respectivesurfaces 276, 278. The bearings 272, 274 also provide for a low frictioncontact with the driving toroidal surfaces 282, 284 and advantageouslyimprove wear-resistant properties.

[0210]FIG. 35 shows a modified embodiment wherein the toroid drive 136has an outer rim 150 a that substantially contacts the bearing surfaces276, 278 mounted on the slide 138 in a low surface area or point contactarrangement. In further embodiments, the cam outer rim 150 can directlycontact the slide bearing surfaces 164 and 166, as needed or desired.

[0211]FIG. 36 shows the operation of the toroidal transmission and powerconverter system 98 in a laboratory system set-up. Rotation of thetoroid drive 136 is about the central rotary axis 232 is converted intolinear reciprocating motion of the slide 138 as generally indicated byarrows 204. The slide is connected to the cutting blade 106. Also shownare the slide bearings 272 and 274.

Irrigation Pump System

[0212] A pulsatile water pump system 290 is incorporated into thedisposable cutting blade assembly 18 and is housed within the distalcover 72. The pulsating water pump 290 supplies sterile water into apatient and in one embodiment is disposed after one use to insure no“patient to patient” bio-contamination. The pulsatile pump system ofembodiments of the invention has utility in a number of fields andapplications where fluid transport is desired. In one embodiment, apulse of water is provided after each linear motion stroke.

[0213] The integrated cutting blade water pump system 290 isadvantageously driven by blade motion and insures that the blade 106will automatically be cooled and lubricated whenever the cutting blade106 is in reciprocating motion. In modified embodiments, an externalpump system may be utilized, as needed or desired.

[0214] The water pump system 290 lubricates the reciprocating blademoving parts. The water pump system 290 cools the reciprocating blademoving parts. The water pump system 290 provides clear water for opticalvision capability.

[0215] The pulsating water pump system 290 more effectively clearsdebris from the cutting blade surface for better cutting performance byproviding pulsed jets of irrigation fluid. The pulsatile water pumpsystem 290 is driven by reciprocating cutting blade motion pumps waterwhenever reciprocating blade 106 is driven. In modified embodiments, thesystem may have a manual override feature for pump operation.

[0216]FIG. 37 shows the pulsatile dual direction water pump system 290in accordance with an embodiment. The pump system 290 has a stationarypump body 292 that includes an inlet 294, a flow chamber 296 and anoutlet 298. The inlet 294 is fed water from the umbilical cord 16 orthrough another feedline. The outlet 298 provides water to the bearingretainer 118 within the blade shield 108. The general direction of flowor the fluid path through the pump 290 is generally indicated by arrows302.

[0217] The inlet 294 has a one-way or check valve 304 and the outlet 298has a one-way or check valve 306 to prevent undesired back-flow. Any oneof a number of suitable valves may be used such as, but not limited to,pressure relief valves, ball-spring devices and the like.

[0218] The pump system 290 includes a pair of spaced spring-biased or-loaded plungers 308, 312. In modified embodiments, other suitableresilient biasing or loading mechanisms may be efficaciously utilized,as needed or desired. The plungers 308, 312 can move back and forth intothe pump chamber 296 to selectively occlude the pump chamber 296 and/orfluid path 302 to displace fluid and pulsatingly pump it to the desiredsite. Water is drawn in from the inlet 294 through the valve 304 as theplungers 308, 312 move back towards their undepressed position.

[0219] The slide 138 has a lower surface 314 with a pair of speciallycontoured and spaced cam surfaces 316, 318 that operatively couple theslide 138 with the pump plungers 308, 312. During a forward linearstroke motion the distal cam surface 316 contacts or abuts the distalplunger 308 and depresses it to pump water out of the outlet 298. Duringa backward linear stroke motion the proximal cam surface 318 contacts orabuts the proximal plunger 312 and depresses it to pump water out of theoutlet 298.

[0220] Thus, the reciprocating linear stroke blade drive motion movescam surfaces 316, 318 to alternatingly depress pump plungers and therebypump water in a pulsing modality whenever the driven cutting blade 106is moved through a linear stroke by the transmission system 98.Desirably, the transmission system 98 provides the motion, force orenergy to substantially simultaneously and synchronously drive thereciprocating blade 106 and the pulsatile pump system 290.

[0221] In embodiments of the invention, the water pump 290 is integratedinto the reciprocating blade mechanism. The pulsatile (pulsating witheach linear stroke) water pump feature pulses a jet of water out throughthe cutting blade irrigation holes 212 to keep the cutting surface 114clean for optimum cutting action. The pulse powered pump 290 is poweredby the reciprocating action of the cutting blade 106. Advantageously,this direct drive eliminates a separate pump drive source. Thisdesirably saves parts and cost by eliminating a separate water pump.

[0222] The disposable cutting tip assembly 18 is sterile. Itincorporates the water pump 290 which is also sterile. The pump 290 isvery close or proximate to the site where the pressurized water isprovided. Advantageously, this reduces pressure losses that would beincurred if the pump is at a distance from the point of use. Itdesirably also solves the problem of sterilizing a far away water pump.

[0223] When the reciprocating blade device 106 is cutting it should beprovided lubrication and cooling and the cutting surface 114 shoulddesirably also remain clean and clear of tissue debris. The water pump290 pumps water when the cutting surface 114 is activated as the samedrive mechanism drives both. Thus, an operator need not remember toactivate the pump 290 since its operation is automatically actuated withcutting blade 106. Desirably, this provides a safety feature to preventdamage, galling, a freeze up and also prevents cutting debris buildupand thermal glazing.

[0224] The pump system 290 can be formed from a number of suitablydurable materials. In one embodiment, the pump system 290 is formed froma suitable plastic. The plastic material may comprise a suitablethermoplastic. In modified embodiments, other suitable plastics, metals,alloys, ceramics, combinations thereof, among others, may beefficaciously utilized, as needed or desired. Suitable surface coatingsor finishes may be applied, as required or desired.

[0225] The pump system 290 can be fabricated by using a number ofmanufacturing techniques. These include, but are not limited to,molding, machining, casting, forging, laser cutting and/or processing,laminating, adhesively fixing, welding, combinations thereof, amongothers, with efficacy, as needed or desired.

[0226]FIG. 38 shows a pulsatile single direction eater pump system 290 ain accordance with another embodiment. The pump system 290 a includes aplunger 320 connected to the slide 138. During forward linear strokemotion the plunger 320 occludes the pump cavity 296 to displace waterform the outlet 298 to the desired site. During backward linear strokemotion the plunger 320 moves in an outward direction from the pumpcavity 296 and water is drawn into the cavity 296 through the inlet 294.

[0227] Powered Handpiece

[0228]FIG. 39 shows the powered handpiece 20 including the cover orhousing 74, the video camera 78, the motor assembly 80 and a distalinterface member 322 for connecting to the interface member 102 andcoupling 104 of the distal tip assembly 18. The interface member 322 hasan opening 324 substantially aligned with the interface opening 158which allow passage of the fiber optic probes 124, 126 for connection tothe camera 78.

[0229] The proximal end 70 of the distal tip assembly 18 and thehandpiece's distal end or portion 326 are configured and adapted toprovide a quick and reliable connection or mating. This includes, but isnot limited to, mechanical docking, electrical docking, optical dockingand hydraulic docking.

[0230] The housing 74 and motor assembly 80 are steam sterilizable. Thesteam sterilization process involves the application of hot water andsteam under pressure to kill germs followed by a partial drying process.The drying process is not always fully complete in that the instrumentsand parts processed, often come back partially wet. Usually there aresmall pockets of standing water trapped in small pools created by partshapes with water-titer pockets that end up facing upward due to thereplacement in the holding trays used to contain the parts and instrumentsto be steam sterilized.

[0231] With the routine use of steam sterilization it is desirable thatany optical or electronic parts that are used with the steam sterilizedinstruments be designed to provide solutions to residual water and theproblems it can create with electromechanical and opto-mechanicalcomponents. As discussed further below, the motor housing also housesthe video camera module, which in inserted into the freshly sterilizedmotor housing. The hermetically sealed video camera module is designedto specifically address the specialized problems of residual water in afreshly steam sterilized surgical instrument in a sterile surgical setupenvironment.

[0232] The handpiece housing 74 has a motor housing 328 that receivesthe motor assembly 80 and the video housing 76 that receives the videocamera 78. The video camera 78 is contained in the video housing 76which provides a hermetically sealed housing. The video housing 76desirably provides a water and gas sealed environmentally protectivehousing. The video camera 78 optically connects to the proximal end 70of the distal tip assembly 18 and interfaces with the imagingfiberoptics.

[0233] The cable 16, the cover 68 and the components of the handpiece 20are sterilizable except for the video camera 78 that is hard tosterilize. During assembly in a sterile field operating room, thenon-sterile video camera 78 is inserted into a freshly sterilizedhandpiece housing 74. A hermetic (gas and liquid) seal is created byO-ring seals or the like. The O-rings are part of the interface at thehandpiece's proximal end 330 and the distal end interface 322.Advantageously, this hardware and procedure combined together enables anon-sterile delicate electronic video camera to be madebacteriologically safe inside the sterile outer housing 74 of thesterilized handpiece 20.

[0234] The housing 74 also contains an LED illuminator 332 that connectsto the illumination fiberoptics of the distal tip assembly 18. The LED(Light Emitting Diode) 332 is also mounted into the video housing 74 ina waterproof and gas-tight method to prevent intrusion and damage fromwater or water vapor accumulation. In one embodiment, a distal videoimaging lens 334 is recessed to help prevent accidental damage.

[0235] The camera 78 can be provided in a mount 336 with an outer shapethat is designed to prevent the incorrect insertion into the housing 74.The mount 336 has a male structure 338 that is received within a matingfemale receptor opening 340 within the housing 74. The male structure338 provides the mount 336 with an asymmetrical cross sectional shapethat is intended to create a visually obvious shape that can be readilyinserted into its mating female receptor opening 340 in the correct ordesired orientation.

[0236] In one embodiment, the camera 78 and the mount 336 comprise avideo module 342 with the camera 78 housed in a waterproof and air-tightmanner as discussed above in connection with the video housing 74. Thehermetically sealed video module 342 can then be fitted within in thehousing 74. The LED 332 can also be hermetically sealed within themodule 342, for example, in an opening 344.

[0237] The camera 78 can comprise any one of a number of suitable videoor digital devices. In one embodiment, the video camera 78 comprises adevice as available from Toshiba. Advantageously, the integration of thevideo camera 78 within the handpiece 20 greatly enhances the capability,compactness, utility and versatility of the system.

[0238] As discussed above, the sterilizable powered handpiece 20contains a non-sterile non-sterilizable video camera 78 contained insidethe sterile hand piece assembly. Advantageously, the sterile poweredhandpiece 20 hermetically seals the non-sterile video camera 78 in asterile housing 74 or 336, which permits safely using the sealedassembly in the sterile field and inside a patients body.

[0239] The handpiece 20 can include one or more switches or buttons thatallows the user to operably control the surgical file operation.Alternatively, or in addition, the controls can be provided on aseparate platform and/or on the control system 14.

[0240] The precision motor 80 can comprise any one of a number ofsuitable rotary motion creating devices such as, but not limited to, gasturbines and electric motors and the like. In one embodiment, the motor80 comprises a gas or air turbine rotary motor that is fed pressurizedair or gas through the umbilical cord 16.

[0241] In one embodiment, the gas turbine motor 80 is provided air orgas at about 80 psi to run the device. In another embodiment, air or gasis provided at a pressure in the range from about 50 psi to about 100psi, including all values and sub-ranges therebetween. In modifiedembodiments, the pressure can be lower or higher, as needed or desired.

[0242] The motor assembly 80 at its distal end or portion 342 includes arotatable power shaft 344 connected to a rotatable drive shaft 346. Themotor distal end 342 docks with the proximal end 70 of the distal tipassembly 18. The power shaft 344 is generally received in the distal tipassembly holes 162, 160 and 149.

[0243] The motor 80 powers the reciprocating blade 106. The male driveshaft 346 is substantially irrotationally received within the matchingfemale receptor hole of the drive shaft 140 to provide rotary motion tothe transmission system 98 that converts it into linear reciprocatingmotion.

[0244]FIG. 40A shows a simple triangular shaft 346 a that can engage thetriangular receptor hole 254 a. When the distal tip assembly 18 and thepowered handpiece 20 are connected both the female triangular receptorhole 254 a and the motor's male triangular drive shaft 346 a can rotatein tandem. The male and female features are free to mesh and alignduring the axial motion of connecting the disposable cutting tipassembly 18 onto the reusable sterilizable motor handpiece 20. Thisdocking feature has a simplified rotary triangular shaped drive shaft,even though it drives a reciprocating (push-pull) motion-cutting blade.

[0245] A triangular shaped male mating drive 346 a is desirable becauseit facilitates sterilization of the male triangular shaft 346 a. Thesurfaces that are steam sterilized and reused are desirably simplesurfaces that are easy to wash and clean. The surfaces should alsoenable reliable cleaning prior to sterilization. The triangular maleshaft 346 a has three flat surfaces that are both easy to see and clean.

[0246] In modified embodiments, other suitable male-female mating drivepolygonal or non-polygonal interlocking configurations may be utilizedwith efficacy, as needed or desired. For example, FIG. 40B shows agenerally square or rectangular male shaft 346 b and FIG. 31C shows agenerally hexagonal male shaft 346 c.

[0247] Surgical Methods

[0248] The methods which are described and illustrated herein are notlimited to the sequence of acts described, nor are they necessarilylimited to the practice of all of the acts set forth. Other sequences ofacts, or less than all of the acts, or simultaneous occurrence of theacts, may be utilized in practicing embodiments of the invention.

[0249] The surgical instrument of embodiments of the invention enablethe removal of obstructions in the tubular spaces (neuroforamen) betweenthe vertebras of the neck and back. Desirably, this allows surgeons tonavigate into the tiny (neuroforamen) canals between delicate nerveroots and remove small amounts of bony overgrowth (osteophytes) underdirect vision.

[0250] Embodiments of the invention allow a surgeon to safely navigatedown into the neuroforamen canal next to the nerve roots and see andremove obstructions that cause nerve compression with direct vision. Thesurgeons can perform a new surgical procedure, a “micro foramentomy”through as small as about a ½ inch to about 1 inch incision. Thisadvantageously represents a truly minimally invasive surgical procedurewhich would serve to benefit patients and surgeons.

[0251]FIGS. 41 and 42 show a bone and/or tissue cutting procedure usingthe surgical instrument 12. The shielded cutting blade 106 is insertedinto a neuroforamen 348 between a vertebra 350, unwanted bone and/ortissue 352 and a nerve root 354. The shield 108 protects the nerve root354 while the blade cutting surface 114 removes the bone and/or tissue354 to relieve nerve compression by enlarging the neuroforamen 348.

[0252] Advantageously, embodiments of the invention provide a high levelof cutting blade control and enable surgeons to reach into previouslyinaccessible areas to remove unwanted bone with precision, sensitivityand complete safety and confidence. The shielded cross sectional profileof embodiments of the cutting tip permit protection of delicate nervesduring the neuroforamen enlargement process to relieve nervecompression.

[0253] As seen in FIG. 42, the shielded portion 108 of the file isfacing the delicate nerve 354 and the opposite cutting surface 114 isfacing the bone that is to be removed 352 to enlargen the bony andcartilage structural opening. Advantageously, the surgical instrument ofembodiments of the invention has a cutting surface 114 that can travelaround corners. A direct vision system allows surgeons to safelynavigate into blind cavities of the patient's body and also assistsvisualization of the actual tissue cutting action and its results.

[0254] In the embodiments of a sterile disposable (one time use) cuttingtip assembly 18, the cutting tip assembly 18 is used typically, in oneembodiment, for about three minutes in a two-hour surgical procedure.The tip of the distal assembly 18 can provide the surgeon with a pictureof the area, and enable the doctor to see the cavity and its anatomicalfeatures.

[0255] The view is magnified so the user sees a full screen image of thesmall tunnel, which is typically, in one embodiment, about one quarterof an inch in diameter. The enlarged view of the area allows surgeons toinspect and find the exact location and size of nerve irritation andcompression, and determine where and how much bone and cartilage toremove to eliminate the nerve compression and relieve the pain.

[0256] Orthopaedic File Embodiment

[0257] FIGS. 43-43 show different views of an orthopaedic shieldedreciprocating surgical file instrument or apparatus 12 a. The surgicalfile instrument 12 a generally comprises a distal tip assembly 18 adocked to and powered by a handpiece 20 a.

[0258] The distal blade assembly 18 a generally comprises areciprocating blade 106 a with a cutting surface 114 a and a shield orguard 108 a. The cutting surface 114 has an abrasive material orabrasives 206 a.

[0259] The distal blade assembly 18 a further includes a handle 356above the blade 106 a. The handle 356 is used by a surgeon to pressagainst or down on the bone and/or tissue material to be removed. Thehandle 356 is shaped to facilitate manipulation and has a suitableergonomic shape or the like. The handle 356 further includes an opening358 to facilitate operation.

[0260] From the foregoing description, it will be appreciated that anovel approach for precision bone and/or tissue removal surgery has beendisclosed. While the components, techniques and aspects of the inventionhave been described with a certain degree of particularity, it ismanifest that many changes may be made in the specific designs,constructions and methodology herein above described without departingfrom the spirit and scope of this disclosure.

[0261] Various modifications and applications of the invention may occurto those who are skilled in the art, without departing from the truespirit or scope of the invention. It should be understood that theinvention is not limited to the embodiments set forth herein forpurposes of exemplification, but is to be defined only by a fair readingof the appended claims, including the full range of equivalency to whicheach element thereof is entitled.

What is claimed is:
 1. A surgical instrument comprising: a blade; ahousing in which the blade moves, the housing having a long axis, saidhousing being concave about at least a distal portion of its long axisand being curved along its long axis; a transmission that convertsrotary motion to reciprocating, linear motion, wherein the transmissionis coupled to the blade such that the blade moves reciprocally in thehousing; a first opening in the housing through which a portion of theblade is exposed; a second opening at a distal end of the housing; acutting surface on said exposed portion of the blade, said surfaceconfigured to perform at least one of grinding, filing, and cutting oftissue; at least one fiberoptic in or on the housing, for transmissionof at least one of a video signal and illumination light; and a pumpthat is mechanically coupled to the transmission.
 2. An apparatus fortranslating a rotary motion to a linear motion, the apparatuscomprising: two surfaces of two respective bearings, the two surfacesbeing a substantially fixed distance apart; and a cam that rotates abouta central axis that is (a) substantially parallel to a direction of thelinear motion of the two surfaces and (b) substantially perpendicular tothe plane extending between the two surfaces; wherein said central axisis at an angle to a plane extending between the two surfaces; the camhaving a curvilinear body of nonuniform thickness, the curvilinear bodybeing disposed at an angle to the central axis of the cam; wherein thecurvilinear body has a shape comprising at least two toruses, the atleast two toruses being partially superimposed, and each of said atleast two toruses has a central axis, wherein the central axes of the atleast two toruses are at an angle to each other; and wherein the bodycontinuously contacts the two surfaces as the cam rotates about thecentral axis, such that the two surfaces remain at the substantiallyfixed distance apart as they move linearly back and forth inreciprocating motion in response to the cam's rotation about the centralaxis.
 3. An apparatus for translating a rotary motion to a linearmotion, the apparatus comprising: two surfaces that are a substantiallyfixed distance apart; and a cam that rotates about a central axis, saidcentral axis being at an angle to a plane extending between the twosurfaces; the cam having a curvilinear body, the body having anonuniform thickness, wherein the body continuously contacts the twosurfaces as the cam rotates about the central axis, such that the twosurfaces remain at the substantially fixed distance apart as they movelinearly in response to the cam's rotation about the central axis. 4.The apparatus of claim 3, wherein said cam's central axis issubstantially parallel to a direction of the linear motion of the twosurfaces.
 5. The apparatus of claim 3, wherein said central axis issubstantially perpendicular to the plane extending between the twosurfaces.
 6. The apparatus of claim 3, wherein the two surfaces movelinearly back and forth in reciprocating motion in response to the cam'srotation about the central axis.
 7. The apparatus of claim 3, whereinthe curvilinear body has a shape comprising at least two toruses, the atleast two toruses being partially superimposed, and each of said atleast two toruses has a central axis, wherein the central axes of the atleast two toruses are at an angle to each other.
 8. The apparatus ofclaim 3, wherein at least one bearing comprises the two surfaces.
 9. Theapparatus of claim 8, wherein two bearings respectively comprise the twosurfaces.
 10. The apparatus of claim 3, wherein the curvilinear body isdisposed at an angle to the central axis of the cam.
 11. An transmissionfor translating a rotary motion to a linear motion, the apparatuscomprising: two surfaces that are a substantially fixed distance apart;a cam that rotates about a central axis, said central axis being at anangle to a plane extending between the two surfaces; and the cam havingmeans for continuously contacting the two surfaces as the cam rotatesabout the central axis, such that the two surfaces remain at thesubstantially fixed distance apart as they move linearly in response tothe cam's rotation about the central axis.
 12. The apparatus of claim11, wherein said cam's central axis is substantially parallel to adirection of the linear motion of the two surfaces.
 13. The apparatus ofclaim 11, wherein said central axis is substantially perpendicular tothe plane extending between the two surfaces.
 14. The apparatus of claim11, wherein the two surfaces move linearly back and forth inreciprocating motion in response to the cam's rotation about the centralaxis.
 15. The apparatus of claim 11, wherein the means for continuouslycontacting the two surfaces has a shape comprising at least two toruses,the at least two toruses being partially superimposed, and each of saidat least two toruses has a central axis, wherein the central axes of theat least two toruses are at an angle to each other.
 16. The apparatus ofclaim 11, wherein the means for continuously contacting the two surfacesis disposed at an angle to the central axis of the cam.
 17. Theapparatus of claim 11, wherein at least one bearing comprises the twosurfaces.
 18. The apparatus of claim 17, wherein two bearingsrespectively comprise the two surfaces.
 19. A surgical instrumentcomprising: a blade; a housing in which the blade moves, the housinghaving a long axis; a transmission that converts rotary motion toreciprocating, linear motion, wherein the transmission is coupled to theblade such that the blade moves reciprocally in the housing; a firstopening in the housing through which a portion of the blade is exposed;and a cutting surface on said exposed portion of the blade, said surfaceconfigured to perform at least one of grinding, filing, and cutting oftissue.
 20. The surgical instrument of claim 19, wherein the housing isconcave about at least a portion of its long axis.
 21. The surgicalinstrument of claim 20, wherein the housing is concave about at least adistal portion of its long axis.
 22. The surgical instrument of claim19, wherein the housing is convex about at least a portion of its longaxis.
 23. The surgical instrument of claim 22, wherein the housing isconvex about at least a distal portion of its long axis.
 24. Thesurgical instrument of claim 19, wherein the first opening is in anopening surface on the housing.
 25. The surgical instrument of claim 19,wherein the housing is curved along its long axis, to assist in placingthe surgical instrument in the body of a patient.
 26. The surgicalinstrument of claim 19, wherein the blade is substantially flat.
 27. Thesurgical instrument of claim 25, wherein the housing is curved along itslong axis in a direction toward the opening surface.
 28. The surgicalinstrument of claim 19, further comprising at least one bearing retainerfor reducing friction.
 29. The surgical instrument of claim 28, whereinsaid at least one bearing retainer has at least one slot configured totransmit fluid toward a distal end of the instrument.
 30. The surgicalinstrument of claim 19, further comprising at least one fiberoptic in oron the housing, for transmission of at least one of a video signal andillumination light.
 31. The surgical instrument of claim 19, wherein thehousing has at least a second opening at a distal end of the housing.32. The surgical instrument of claim 30, further comprising at least twolenses coupled to the at least one fiberoptic.
 33. The surgicalinstrument of claim 32, wherein at least one of the at least two lensesis disposed at a distal end of the housing, and another of the at leasttwo lenses is disposed in proximity to the first opening in the housing.34. The surgical instrument of claim 19, further comprising a pump forpumping fluid through the surgical instrument.
 35. The surgicalinstrument of claim 34, wherein the pump is mechanically coupled to thetransmission.
 36. The surgical instrument of claim 19, wherein thetransmission comprises: two surfaces that are a substantially fixeddistance apart; a cam that rotates about a central axis, said centralaxis being at an angle to a plane extending between the two surfaces;and the cam having a curvilinear body, the body having a nonuniformthickness, wherein the body continuously contacts the two surfaces asthe cam rotates about the central axis, such that the two surfacesremain at the substantially fixed distance apart as they move linearlyin response to the cam's rotation about the central axis.
 37. Theapparatus of claim 36, wherein said cam's central axis is substantiallyparallel to a direction of the linear motion of the two surfaces. 38.The apparatus of claim 36, wherein said central axis is substantiallyperpendicular to the plane extending between the two surfaces.
 39. Theapparatus of claim 36, wherein the two surfaces move linearly back andforth in reciprocating motion in response to the cam's rotation aboutthe central axis.
 40. The apparatus of claim 36, wherein the curvilinearbody has a shape comprising at least two toruses, the at least twotoruses being partially superimposed, and each of said at least twotoruses has a central axis, wherein the central axes of the at least twotoruses are at an angle to each other.
 41. The apparatus of claim 36,wherein at least one bearing comprises the two surfaces.
 42. Theapparatus of claim 41, wherein two bearings respectively comprise thetwo surfaces.
 43. The apparatus of claim 36, wherein the curvilinearbody is disposed at an angle to the central axis of the cam.
 44. Thesurgical instrument of claim 19, wherein the transmission comprises: twosurfaces that are a substantially fixed distance apart; rotation meansthat rotates about a central axis, said central axis being at an angleto a plane extending between the two surfaces; and the rotation meanscontinuously contacting the two surfaces as the rotation means rotatesabout the central axis, such that the two surfaces remain at thesubstantially fixed distance apart as they move linearly in response tothe rotation means's rotation about the central axis.
 45. The apparatusof claim 44, wherein said cam's central axis is substantially parallelto a direction of the linear motion of the two surfaces.
 46. Theapparatus of claim 44, wherein said central axis is substantiallyperpendicular to the plane extending between the two surfaces.
 47. Theapparatus of claim 44, wherein the two surfaces move linearly back andforth in reciprocating motion in response to the cam's rotation aboutthe central axis.
 48. The apparatus of claim 44, wherein at least onebearing comprises the two surfaces.
 49. The apparatus of claim 48,wherein two bearings respectively comprise the two surfaces.
 50. Theapparatus of claim 44, wherein the curvilinear body has a shapecomprising at least two toruses, the at least two toruses beingpartially superimposed, and each of said at least two toruses has acentral axis, wherein the central axes of the at least two toruses areat an angle to each other.
 51. The apparatus of claim 44, wherein thecurvilinear body is disposed at an angle to the central axis of the cam.52. The surgical instrument of claim 19, wherein the transmissioncomprises: two surfaces that are a substantially fixed distance apart; acam that rotates about a central axis, said central axis being at anangle to a plane extending between the two surfaces; and the cam havingmeans for continuously contacting the two surfaces as the cam rotatesabout the central axis, such that the two surfaces remain at thesubstantially fixed distance apart as they move linearly in response tothe cam's rotation about the central axis.
 53. The apparatus of claim52, wherein said cam's central axis is substantially parallel to adirection of the linear motion of the two surfaces.
 54. The apparatus ofclaim 52, wherein said central axis is substantially perpendicular tothe plane extending between the two surfaces.
 55. The apparatus of claim52, wherein the two surfaces move linearly back and forth inreciprocating motion in response to the cam's rotation about the centralaxis.
 56. The apparatus of claim 52, wherein the means for continuouslycontacting the two surfaces has a shape comprising at least two toruses,the at least two toruses being partially superimposed, and each of saidat least two toruses has a central axis, wherein the central axes of theat least two toruses are at an angle to each other.
 57. The apparatus ofclaim 52, wherein at least one bearing comprises the two surfaces. 58.The apparatus of claim 57, wherein two bearings respectively comprisethe two surfaces.
 59. The apparatus of claim 52, wherein the means forcontinuously contacting the two surfaces is disposed at an angle to thecentral axis of the cam.
 60. A pump comprising: a fluid path; twoplungers configured to at least partially occlude said fluid path; a camconfigured to cause said two plungers to at least partially occlude saidfluid path alternatingly; and at least one check valve along said fluidpath for reducing backflow of fluid within said fluid path.
 61. The pumpof claim 60, wherein the cam translates in a direction that issubstantially perpendicular to a long axis of at least one of said twoplungers.
 62. The pump of claim 61, wherein the cam translates in adirection that is substantially perpendicular to a long axis of each ofsaid two plungers.
 63. A pump comprising: a fluid path; two plungersconfigured to at least partially occlude said fluid path; means forcausing said two plungers to at least partially occlude said fluid pathalternatingly; and at least one check valve along said fluid path forreducing backflow of fluid within said fluid path.
 64. The surgicalinstrument of claim 34, wherein the pump comprises: a fluid path; twoplungers configured to at least partially occlude said fluid path; a camconfigured to cause said two plungers to at least partially occlude saidfluid path alternatingly; and at least one check valve along said fluidpath for reducing backflow of fluid within said fluid path.
 65. Thesurgical instrument of claim 64, wherein the cam translates in adirection that is substantially perpendicular to a long axis of at leastone of said two plungers.
 66. The pump of claim 65, wherein the camtranslates in a direction that is substantially perpendicular to a longaxis of each of said two plungers.
 67. The surgical instrument of claim35, wherein the pump comprises: a fluid path; two plungers configured toat least partially occlude said fluid path; a cam configured to causesaid two plungers to at least partially occlude said fluid pathalternatingly; and at least one check valve along said fluid path forreducing backflow of fluid within said fluid path.
 68. The surgicalinstrument of claim 67, wherein the cam translates in a direction thatis substantially perpendicular to a long axis of each of said twoplungers.
 69. The surgical instrument of claim 19, further comprising atleast one opening in the exposed portion of the blade, for transmittingfluid.
 70. The surgical instrument of claim 19, wherein the cuttingsurface comprises an abrasive material.
 71. The surgical instrument ofclaim 19, wherein the cutting surfaces comprises diamond.
 72. Thesurgical instrument of claim 19, wherein the blade comprises stainlesssteel.
 73. The surgical instrument of claim 19, further comprising ahandpiece coupled to the housing.
 74. The surgical instrument of claim19, further comprising a video camera.
 75. The surgical instrument ofclaim 74, wherein the camera is configured to couple with a fiberopticthat extends to a distal end of the housing.
 76. The surgical instrumentof claim 73, wherein a video camera is located in the handpiece.
 77. Thesurgical instrument of claim 76, further comprising a watertight seal inthe handpiece.
 78. The surgical instrument of claim 77, wherein thehandpiece is configured to contain the video camera in a chamber suchthat the watertight seal reduces or prevents ingress of at least one ofwater and bacteria from outside the handpiece into the chambercontaining the video camera in the handpiece.
 79. The surgicalinstrument of claim 73, further comprising a motor in the handpiece,said motor configured to power the rotary motion.
 80. The surgicalinstrument of claim 79, wherein said motor comprises a gas turbine. 81.The surgical instrument of claim 19, further comprising a cordconfigured to couple to a proximal end of the surgical instrument, saidcord comprising at least one of a fiberoptic, an electrical line, anirrigation channel, a suction line, and a gas tube for powering a gasturbine motor in the surgical instrument.
 82. A surgical instrumentcomprising: a blade; a housing in which the blade moves, the housinghaving a long axis; converting means for converting rotary motion toreciprocating, linear motion, wherein the converting means is coupled tothe blade such that the blade moves reciprocally in the housing; a firstopening in the housing through which a portion of the blade is exposed;and a cutting surface on said exposed portion of the blade, said surfaceconfigured to perform at least one of grinding, filing, and cutting oftissue.
 83. The surgical instrument of claim 82, wherein the blade issubstantially flat.
 84. The surgical instrument of claim 82, wherein thehousing is concave about at least a portion of its long axis.
 85. Thesurgical instrument of claim 84, wherein the housing is concave about atleast a distal portion of its long axis.
 86. The surgical instrument ofclaim 82, wherein the housing is convex about at least a portion of itslong axis.
 87. The surgical instrument of claim 86, wherein the housingis convex about at least a distal portion of its long axis.
 88. Thesurgical instrument of claim 82, wherein the housing is curved along itslong axis to assist in placing the surgical instrument in the body of apatient.
 89. The surgical instrument of claim 82, further comprising atleast one bearing retainer for reducing friction.
 90. The surgicalinstrument of claim 89, wherein said at least one bearing retainer hasat least one slot configured to transmit fluid toward a distal end ofthe instrument.
 91. The surgical instrument of claim 82, furthercomprising at least one fiberoptic in or on the housing, fortransmission of at least one of a video signal and illumination light.92. The surgical instrument of claim 82, wherein the housing has atleast a second opening at a distal end of the housing.
 93. The surgicalinstrument of claim 91, further comprising at least two lenses coupledto the at least one fiberoptic.
 94. The surgical instrument of claim 93,wherein at least one of the at least two lenses is disposed at a distalend of the housing, and at least another of the at least two lenses isdisposed in proximity to the first opening in the housing.
 95. Thesurgical instrument of claim 82, further comprising a pump for pumpingfluid through the surgical instrument.
 96. The surgical instrument ofclaim 95, wherein the pump is mechanically coupled to the transmission.97. A surgical instrument comprising: a blade; a housing in which theblade moves, the housing having a long axis; converting means forconverting rotary motion to reciprocating, linear motion, wherein theconverting means is coupled to the blade such that the blade movesreciprocally in the housing; a first opening in the housing throughwhich a portion of the blade is exposed; and cutting means on saidexposed portion of the blade, said cutting means configured to performat least one of grinding, filing, and cutting of tissue.
 98. Thesurgical instrument of claim 97, wherein the blade is substantiallyflat.
 99. An apparatus for translating a rotary motion to a linearmotion, the apparatus comprising: two surfaces that are a substantiallyfixed distance apart; and rotation means that rotates about a centralaxis, said central axis being at an angle to a plane extending betweenthe two surfaces; wherein the rotation means is configured tocontinuously contact the two surfaces as the rotation means rotatesabout the central axis, such that the two surfaces remain at thesubstantially fixed distance apart as they move linearly in response tothe rotation means's rotation about the central axis.
 100. The apparatusof claim 99, wherein at least one bearing comprises the two surfaces.101. The apparatus of claim 100, wherein two bearings respectivelycomprise the two surfaces.
 102. The apparatus of claim 99, wherein saidrotation means's central axis is substantially parallel to a directionof the linear motion of the two surfaces.
 103. The apparatus of claim99, wherein said central axis is substantially perpendicular to theplane extending between the two surfaces.
 104. The apparatus of claim99, wherein the two surfaces move linearly back and forth inreciprocating motion in response to the rotation means's rotation aboutthe central axis.
 105. The apparatus of claim 99, wherein the rotationmeans has a shape comprising at least two toruses, the at least twotoruses being partially superimposed, and each of said at least twotoruses has a central axis, wherein the central axes of the at least twotoruses are at an angle to each other.